Tumour necrosis factor alpha and use of infliximab. Safety during pregnancy.

QUESTION: A 27-year-old patient of mine with rheumatoid arthritis has been treated with infliximab for the last 5 years. She is planning her first pregnancy. How should I advise her regarding use of infliximab during pregnancy, bearing in mind that infliximab substantially improved her medical condition? ANSWER: Infliximab (Remicade) has not been tested in pregnant animals because it does not interact with non-human tumour necrosis factor (TNF) alpha. Several case reports describing women who used infliximab during pregnancy do not suggest a strong association with adverse pregnancy outcomes. More studies are required to determine infliximab's safety during pregnancy.