PREGNANCY SUMMARIES: Adalimumab in Pregnancy
Briggs, Freeman, & Yaffe – No developmental toxicity attributable to adalimumab has been observed in a limited number of cases, and the animal data suggest low risk. However, the limited human pregnancy experience prevents a more complete assessment of embryo-fetal risk. Theoretically, tumor necrosis factor-alpha (TNF) antagonists could interfere with implantation and ovulation, but this has not been show clinically (1). The maternal benefits from treatment with adalimumab appear to far outweigh the unknown embryo-fetal risks (2, 3). It is not known if the antibody can cross the placenta early in gestation when most adalimumab exposures have occurred. If it is similar to immunoglobulin G (IgG), clinically significant amounts would cross only late in gestation and thus would present no direct risk to the embryo-fetus during early development. Because of the long elimination half-life, use before conception may result in inadvertent exposure of an unplanned pregnancy.