Anti-TNF continuation after pregnancy prevents relapse in women with IBD

Treatment continuation with antitumour necrosis factor (anti-TNF) after 24 weeks of pregnancy seems to provide benefits in terms of inflammatory bowel disease (IBD) activity and prematurity without affecting neonatal outcomes and serious infections in newborns, reports a study.

A target trial emulation between 2010 and 2020 was conducted involving all pregnancies with birth exposed to anti-TNF between conception and 24 weeks of pregnancy in women with IBD.

The researchers used inverse probability‒weighted marginal models to compare the occurrence of maternal IBD relapse up to 6 months postpregnancy, adverse pregnancy outcomes, and serious infections in the offspring during the first 5 years of life.

Of the 5,293 pregnancies included, 2,890 discontinued anti-TNF treatment before 24 weeks while 2,403 continued it beyond 24 weeks.

Anti-TNF continuation resulted in reduced frequencies of maternal IBD relapse (35.8 percent vs 39.0 percent; adjusted risk ratio [aRR], 0.93, 95 percent confidence interval [CI], 0.86‒0.99) and prematurity (7.6 percent vs 8.9 percent; aRR, 0.82, 95 percent CI, 0.68‒0.99).

On the other hand, treatment continuation showed no difference in stillbirths (0.4 percent vs 0.2 percent; aRR, 2.16, 95 percent CI, 0.64‒7.81), small weight for gestational age births (13.1 percent vs 12.9 percent; aRR, 1.01, 95 percent CI, 0.88‒1.17), and serious infections in infants (54.2 percent vs 50.2 percent per 1,000 person-years; adjusted hazard ratio, 1.08, 95 percent CI, 0.94‒1.25).

The study was limited by the use of algorithms instead of clinical data in identifying IBD patients, pregnancies, and serious infections.