Taking Remicade for arthritis during pregnancy is safe

Remicade contains active substance infliximab and is used to treat some kinds of autoimmune diseases such as rheumatoid arthritis, ulcerative colitis, ankylosing spondylitis, psoriasis, psoriatic arthritis and Crohn’s disease. Remicade is called a tumor necrosis factor (TNF) inhibitor because it binds and blocks TNF. TNF is a substance in the body that causes inflammation in the joints, skin and spine.

Remicade has been assigned to pregnancy category B. Reproduction studies on animals have not been conducted with Remicade. There are no controlled information in human pregnancy. Remicade is only recommended for use during pregnancy when benefits outweigh risks.

Very small researches has been made on infliximab use during pregnancy. In a study sent to rheumatologists, the doctors reported no increase in birth defects or miscarriage rates in 417 women exposed to infliximab or another TNF inhibitor during pregnancy. About 1/3 of these pregnant women continued to take the medicine throughout entire pregnancy. An analysis of cases reported to the Remicade safety did not find an increased risk in birth defects or miscarriage rates in 78 pregnant women. Most of these women took Remicade during the first trimester or within three months prior to conception. Other smaller studies have not found an increased number of birth defects in babies born to women taking Remicade during entire pregnancy. In order to determine if infliximab is safe to use during pregnancy, results from more studies are needed.

Information was available for the outcomes of 10 of the 15 pregnancies where the partner of the woman was exposed to infliximab. 8 of the 10 patients received infliximab within 3 months of their partner's conception, 3 of whom were treated both before their partner's conception and during the first trimester. The results were 9 live births and 1 spontaneous miscarriage.

Infliximab is a very large protein, so it is not likely that very much of the medication would be able to pass into breast milk. Also in addition, infliximab is not well absorbed from the intestines, so any of the medication that gets into breast milk would be unlikely to enter the baby’s system. However, it is possible that premature born babies with immature digestive systems may be able to absorb more of the medication through breast milk. A few reports of women breastfeeding while taking Remicade showed no significant transfer of the medication into breast milk. Be sure to discuss options concerning breastfeeding with your doctor or pharmacist.