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Case Reports
. 2021 Dec;14(4):260-262.
doi: 10.1177/1753495X20966094. Epub 2020 Oct 29.

Tocilizumab drug levels during pregnancy and lactation: A woman who discontinued tocilizumab therapy until the end of the first trimester and resumed it after birth

Jumpei Saito  1 , Naho Yakuwa  2 , Kayoko Kaneko  3 , Mikako Goto  2 , Hiroyo Kawasaki  1 , Yurie Hamamachi  1 , Tomo Suzuki  4 , Haruhiko Sago  4 , Akimasa Yamatani  1 , Atsuko Murashima  2   3   4
Affiliations
Case Reports

Tocilizumab drug levels during pregnancy and lactation: A woman who discontinued tocilizumab therapy until the end of the first trimester and resumed it after birth

Jumpei Saito et al. Obstet Med. 2021 Dec.

Abstract

The demand for tocilizumab is increasing in women who wish to bear children and who have active rheumatoid arthritis. Described here is a woman with rheumatoid arthritis who discontinued her tocilizumab therapy at the end of the first trimester and resumed it after delivery and where tocilizumab levels in maternal serum, infant serum, and the breast milk were measured. Tocilizumab was not detected in maternal serum just before delivery, or in umbilical cord blood or infant serum after birth. Tocilizumab levels in colostrum after intravenous injection were 0.57% of those in serum. Tocilizumab treatment in the first trimester was not associated with a significant drug level in the fetus at delivery and no fetal complications were noted .

Keywords: Rheumatoid arthritis; breastfeeding; pregnancy; tocilizumab.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. A. Murashima has received research grants from Astellas Pharma Inc., and Chugai Pharmaceutical Co. Ltd., and has received lecture fees from Astellas Pharma Inc., Chugai Pharmaceutical Co. Ltd., and Bristol-Myers K.K. All other authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Tocilizumab concentrations in serum and breast milk. Tocilizumab concentrations in maternal serum at delivery were under the limit of detection (LOD, 0.002 μg/mL). Tocilizumab concentrations in cord blood and infant serum at delivery were also under the LOD. X-axis, postpartum weeks. Closed squares indicate the concentrations of tocilizumab in breast milk (left Y-axis). Open circles indicate the concentrations of tocilizumab in maternal serum (right Y-axis).
See this image and copyright information in PMC

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