Treatment of Crohn's disease with Adalimumab in pregnancy – a case report

Aims: The fully recombinant human IgG1 antibody adalimumab (Humira, Abbott Laboratories) became an alternative option for treatment of Inflammatory bowel disease. Since many young women in childbearing age are affected by Crohn's disease (CD), it is important to investigate the influences and effects of TNF-α-antibodies regarding the fetal safety. Although infliximab seems to be a safe drug given in conception and pregnancy (Schnitzler F. et al.; DDW 2007), the number of data concerning the effects on conception and gravidity are scarce. Therefore we report of a case of pregnancy and the appliance of adalimumab therapy during conception.

Methods: We describe a 32yrs. old woman presenting with CD at our IBD-center in February 2004. In April 2002 CD was diagnosed and initially treated with steroids. In following treatment with azathioprine failed due to the development of a drug induced pancreatitis. The patient then had an excellent response to infliximab and was kept in remission by regular infusions until 20 months later, when she lost response and expired a new flare (CDAI 170). We then decided for off-label treatment with adalimumab, starting with an initial dose of 160mg in November 2005, continued by 80mg every other week (eow). Remission (CDAI 0) was achieved in January 2006 and the dose was reduced to adalimumab 40mg eow for maintenance. She received 18 doses 40mg until October 2006, when we stopped due to diagnose of pregnancy in seventh week of gestation.

Results: After 40 weeks and 2 days of gestation a spontaneous and uncomplicated delivery finished the period of gravity. Remission was still ongoing without any disease activity, although an interim increase of inflammatory parameters (CRP 2.6mg/dl) in February 2007 was noted. The routinely performed screening examinations at the department of gynaecology (Klinikum Grosshadern, Munich) did not show any abnormalities in fetal growth and development. On June 20th, 2007 our patient delivered a healthy and regular developed girl (APGAR 10/10/10, weight 3360g, height 54cm).

Conclusion: Current data do not implicate an increased risk in the application of TNF-α-substances during pregnancy. Further observations of larger cohorts are required before any final conclusions can be drawn.