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5 Settembre 2022
Ghalandari N, Crijns HJMJ, Bergman JEH, et al.

Reported congenital malformations after exposure to non-tumour necrosis factor inhibitor biologics: a retrospective comparative study in EudraVigilance

Br J Clin Pharmacol. 2022 Jul 27. Online ahead of print
  • Il presente studio retrospettivo di comparazione ha analizzato il database EudraVigilance (EV) per valutare il numero e la natura delle malformazioni congenite dopo esposizione fetale intrauterina ai biologici non inibitori del fattore di necrosi tumorale rispetto al certolizumab pegol.
  • Non sono state identificate particolari segnalazioni relative alla sicurezza sullo sviluppo di malformazioni congenite dopo esposizione a ixekizumab (n = 29), abatacept (n = 64), anakinra (n = 20), belimumab (n = 93), rituximab (n = 57), secukinumab (n = 128), tocilizumab (n = 124) e ustekinumab (n = 215).
  • In relazione ai casi di agenesia del corpo calloso riscontrati nel gruppo del vedolizumab (n = 113), non possono essere stabilite solide conclusioni in base alle informazioni disponibili.

Abstract

Aims
To evaluate the number and nature of reported congenital malformations (CMs) after intrauterine exposure to non-tumour necrosis factor inhibitor biologics (non-TNFi biologics) compared to certolizumab pegol (CZP).

Methods
A retrospective comparative study was conducted in the EudraVigilance (EV) database. A safe biologic (CZP) was considered as the reference group. Odds ratios (ORs) for CMs were calculated for each non-TNFi biologic (including abatacept, anakinra, belimumab, ixekizumab, rituximab, secukinumab, tocilizumab, ustekinumab and vedolizumab), versus CZP (quantitative assessment). Then, CM patterns were reviewed in consultation with a clinical geneticist (qualitative assessment).

Results
ORs were not statistically significant except for belimumab and vedolizumab (similar in magnitude). Except for vedolizumab, no specific CM patterns were observed for the included non-TNFi biologics. Three cases of corpus callosum agenesis (CCA) were identified for vedolizumab (versus none in CZP and other investigated non-TNFi biologics). Two of the CCA cases were associated with other neurological CMs (one cerebral ventriculomegaly with microcephaly and one polymicrogyria). This may indicate that these CCAs are related to undiagnosed genetic alterations or are associated with the underlying maternal disease, although a definite relationship with vedolizumab exposure cannot be ruled out.

Conclusions
No special safety signal was identified regarding the occurrence of CMs after exposure to abatacept (n = 64), anakinra (n = 20), belimumab (n = 93), ixekizumab (n = 29), rituximab (n = 57), secukinumab (n = 128), tocilizumab (n = 124) and ustekinumab (n = 215). Regarding observed CCAs in the vedolizumab group (n = 113), no firm conclusions can be made based on available information.

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