Infections graves chez les enfants nés de mères atteintes de MICI avec exposition in utero aux thiopurines et aux anti-TNF
BACKGROUND AND AIMS
We aimed to compare the risk of serious infections in children with in utero exposure to thiopurines and/or anti-TNF born to mothers with inflammatory bowel disease.
Methods
Using the French national health database, which covers 99% of the French population (around 66,000,000 people), we identified livebirths among women with inflammatory bowel disease in France between 2010 and 2018. The risks of serious infections in children during the first five years of life were compared according to treatment exposures during pregnancy using propensity score-weighted marginal Cox models.
Results
26,561 children were included: 3,392 were exposed to thiopurine monotherapy, 3,399 to anti-TNF monotherapy, 816 to combination therapy, and 18,954 were not exposed to any of these drugs. The risks of serious infections during the first year of life among children exposed to thiopurine monotherapy (aHR 0.94; 95%CI: 0.83-1.07) and anti-TNF monotherapy (aHR 1.10; 95%CI: 0.95-1.27) were similar to those of unexposed children; a higher risk was observed in children exposed to combination therapy (aHR 1.36; 95%CI: 1.04-1.79). The highest increased risks were observed for nervous system infections and viral infections. The risk of serious infections during the second to fifth years of life was not associated with IBD treatments.
Conclusion
In children born to mothers with IBD, in utero exposure to thiopurine and anti-TNF monotherapies do not increase the risk of serious infections during the first five years of life. Combination therapy is associated with an increased risk of serious infections during the first year of life.
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