Use of Two Biologics During Pregnancy: Infliximab and Vedolizumab: A Case Study.
Birgit Hoekstra, Dianne G Bouwknegt, Paola Mian et al.
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Case in brief
A 32-year-old woman with severe juvenile idiopathic arthritis and Crohn disease continued infliximab and vedolizumab throughout pregnancy. Therapeutic drug concentrations were monitored, and both diseases remained controlled. The pregnancy was complicated by gestational diabetes and mild polyhydramnios, followed by preterm delivery at 33 weeks and 5 days. The infant weighed 2425 g (p85), without growth retardation. Drug-level-guided dose adjustments were made on expert advice because validated pregnancy dosing guidelines were lacking; preterm birth nevertheless occurred.
What made this case unusual
The case describes dual biologic therapy with infliximab and vedolizumab maintained throughout pregnancy, with therapeutic drug monitoring used to guide dosing despite the absence of validated pregnancy-specific dosing guidelines.
Diagnostic / clinical pearl
Drug concentrations may change differently during pregnancy for infliximab and vedolizumab; interpreting levels alongside disease activity and individual circumstances can inform dosing, although validated pregnancy-specific guidance is lacking.
Why it matters
The report highlights the need for multidisciplinary care and prospective study of drug concentrations, disease activity, and pregnancy outcomes with dual biologic therapy.