Table 7.
Monoclonal Antibodies Used in Pregnancy
| Name | Structure | Route of Administration | Indication | Clinical Considerations in Pregnancy |
|---|---|---|---|---|
| Anti-TNFα | ||||
| Adalimumab | Human anti-TNFα IgG1 | SC injection | RA, JIA, PsA, AS, CD, UC, Ps, HS, UV | Placental transfer increases as pregnancy progresses and may affect the immune response in fetus. Risk-benefits should be considered prior to use |
| Infliximab | Chimeric murine-human anti-TNFα IgG1 | IV injection | CD, UC, RA, AS, PsA, Ps | Placental transfer during the third trimester of pregnancy may affect the immune response and increase the risk of infections in fetus |
| Certolizumab | Humanized PEGylated Fab of anti-TNFα IgG1 | SC injection | CD, RA, PsA, AS, NAS, Ps | Placental transfer is negligible or very minimal. Fetal risk is anticipated to be minimal |
| Golimumab | Human anti-TNFα IgG1 | SC injection | RA, PsA, AS, UC | Crosses the placenta and may affect the immune response in fetus |
| Anti-IL receptor | ||||
| Tocilizumab | Humanized anti-IL-6 receptor IgG1 | IV infusion or SC injection | RA, GCA, SSc-ILD, PJIA, SJIA, CRS | Placental transfer increases as pregnancy progresses. Risk-benefits should be considered prior to use |
| Canakinumab | Human anti-IL-1β receptor IgG1 | SC injection | PFS, Still disease | Placental transfer increases as pregnancy progresses. Risk-benefits should be considered prior to use |
| Anti-complement C5 | ||||
| Eculizumab | Humanized anti-complement C IgG2 | IV infusion | PNH, aHUS, gMG in adults who are AchR antibody positive, NMOSD in adults who are AQP4 antibody positive | Placental transfer is minimal. Fetal risk is anticipated to be minimal |
| Anti-integrin | ||||
| Vedolizumab | Humanized anti-α4β7-integrin IgG1 | IV infusion | CD, UC | Placental transfer is minimal. Fetal risk is anticipated to be minimal |
| Natalizumab | Humanized anti-α4-integrin IgG4 | IV infusion | CD, MS | Placental transfer increases as pregnancy progresses. Risk-benefits should be considered prior to use |
| Anti–B cell | ||||
| Belimumab | Human anti-BLyS IgG1 | IV infusion: pediatric patients (≥5 years); SC injection: adults (≥ 18 years) | SLE and adjunct therapy for lupus nephritis | Placental transfer increases as pregnancy progresses. Risk-benefits should be considered prior to use |
| Anti-immunoglobulin | ||||
| Omalizumab | Humanized anti-IgE IgG1 | SC injection | Asthma, nasal polyps, chronic spontaneous urticaria | Placental transfer increases as pregnancy progresses. Risk-benefits should be considered prior to use |
AchR, acetylcholine receptor; aHUS, atypical hemolytic uremic syndrome; AQP4, aquaporin-4; AS, ankylosing spondylitis; BLyS, B-lymphocyte stimulator; CD, Crohn disease; CRNP, chronic rhinosinusitis with nasal polyposis; CRS, cytokine release syndrome; GCA,giant cell arteritis; gMG, generalized myasthenia gravis; HS, hidradenitis suppurativa; IgG, immunoglobulin G; IL, interleukin; IV, intravenous; JIA, juvenile idiopathic arthritis; MS, multiple sclerosis; NAS, nonradiographic spondyloarthritis;NMOSD,neuromyelitis optica spectrum disorder;PFS,periodic fever syndrome;PJIA,polyarticular juvenile idiopathic arthritis;PNH,paroxysmal nocturnal hemoglobinuria; Ps,plaque psoriasis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SC,subcutaneous; SJIA,systemic juvenile idiopathic arthritis; SLE, systemic lupus erythematosus; SSc-ILD,systemic sclerosis–associated interstitial lung disease; TNFα, tumor necrosis factor-α; UC, ulcerative colitis; UV, uveitis. The clinical recommendations considering the risk-benefit of monoclonal antibodies in pregnant women were obtained from an extensive review of the literature.