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The Effect of Maternal Peripartum Anti-TNFα Use on Infant Immune Response

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Abstract

Background

Infliximab (IFX) and adalimumab (ADA) cross the placenta in the third trimester and can be detectable in infants for up to 12 months.

Aim

The aim of this study was to determine whether in utero IFX or ADA exposure results in an impaired immune response in infants, as measured by immunoglobulin levels and antibody responses to routine primary immunizations.

Methods

Infants who were exposed to in utero anti-TNFα agents were prospectively evaluated. Immunoglobulin levels (IgG, IgM, IgA) and antibodies to standard vaccinations, including tetanus toxoid (tetanus) and Haemophilus influenza type b (Hib), were measured in infants of at least 6 months of age.

Results

Twelve infants were prospectively studied: 10 exposed to in utero IFX and 2 exposed to ADA with at least one dose administered in the third trimester. Immunoglobulin levels were available on 10/12 patients, with all showing adequate immunoglobulin levels, except for low IgM levels in 5 (50 %) infants. Adequate responses to both the tetanus and Hib vaccines were seen in 11 of 12 (92 %) infants.

Conclusions

Infants exposed to anti-TNFα agents in utero demonstrate appropriate response to two commonly administered neonatal vaccines and show adequate immunoglobulin levels, except for IgM. Newborns with a history of exposure to anti-TNFα agents should follow a standard vaccination schedule for inactive vaccines.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Sarah Sheibani & Uma Mahadevan

  2. Division of Gastroenterology, Department of Medicine, University of Chicago, Chicago, IL, USA

    Russell Cohen

  3. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Sunanda Kane

  4. Division of Gastroenterology, Department of Medicine, Mt. Sinai Medical Center, New York, NY, USA

    Marla Dubinsky

  5. Division of Clinical Immunology and Allergy, Department of Pediatrics, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Joseph A. Church

  6. Division of Gastroenterology, University of Southern California, Keck School of Medicine, 1520 San Pablo Street, Suite 1000, Los Angeles, CA, 90033-5312, USA

    Sarah Sheibani

Authors
  1. Sarah Sheibani
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  2. Russell Cohen
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  3. Sunanda Kane
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  4. Marla Dubinsky
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  5. Joseph A. Church
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  6. Uma Mahadevan
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Corresponding author

Correspondence to Sarah Sheibani.

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Conflict of interest

Sarah Sheibani and Joseph Church have no conflicts of interest. Russell Cohen: Speaker’s Bureau, AbbVie, Entera Health, Takeda. Consultant, AbbVie, Celgene, Entera Health, Hospira, Janssen, Sandoz Biopharmaceuticals, Takeda, UCB. Clinical Trials (Principal Investigator), Astra-Zeneca, Celgene, Gilead, Mesoblast Ltd., Osiris. Therapeutics, Pfizer, Receptos, RedHill Biopharma, Sanofi-Aventis, UCB. Sundanda Kane: Research Support, UCB. Consultant, AbbVie. Marla Dubinksy: Consultant, Janssen, AbbVie, Takeda, Genentech, Boehringer Ingelheim, Celgene. Uma Mahadevan: Consultant, Janssen, AbbVie, UCB.

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Sheibani, S., Cohen, R., Kane, S. et al. The Effect of Maternal Peripartum Anti-TNFα Use on Infant Immune Response. Dig Dis Sci 61, 1622–1627 (2016). https://doi.org/10.1007/s10620-015-3992-2

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  • DOI: https://doi.org/10.1007/s10620-015-3992-2

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