Vedolizumab and chickenpox in immune patient during pregnancy

Authors

  • Silvia Bonassisa Department of Gynaecology and Obstetrics, University of Piemonte Orientale, AOU Maggiore della Carità, Via Mazzini 28, 28100, Novara, Italy
  • Carmen Imma Aquino Department of Gynaecology and Obstetrics, University of Piemonte Orientale, AOU Maggiore della Carità, Via Mazzini 28, 28100, Novara, Italy
  • Alessandro Libretti Department of Gynaecology and Obstetrics, University of Piemonte Orientale, AOU Maggiore della Carità, Via Mazzini 28, 28100, Novara, Italy
  • Roberta Amadori Department of Gynaecology and Obstetrics, University of Piemonte Orientale, AOU Maggiore della Carità, Via Mazzini 28, 28100, Novara, Italy
  • Valentino Remorgida Department of Gynaecology and Obstetrics, University of Piemonte Orientale, AOU Maggiore della Carità, Via Mazzini 28, 28100, Novara, Italy
  • Daniela Surico Department of Gynaecology and Obstetrics, University of Piemonte Orientale, AOU Maggiore della Carità, Via Mazzini 28, 28100, Novara, Italy

Keywords:

pregnancy, obstetrics, abortion, complications

Abstract

Vedolizumab (VDZ) is a humanized immunoglobulin G1 monoclonal antibody approved for use in adults affected by moderately to severely active Crohn’s disease (CD) and ulcerative colitis (UC). In accordance with the Food and Drug Administration (FDA), VDZ is safe during pregnancy. Immunosuppressive drugs increase the risk of infections especially when used in combination, but some treatments may also expose the patients to the reactivation of latent infections. A 39-years old pregnant woman G1 P0 started immunosuppressive therapy with Vedolizumab, after the failure of previous treatments. She had already been tested for HBV, EBV and VZV, in addition to previous serology, resulting in immunity. At the 12 weeks of pregnancy, a first suspicious symptomatology for VZV began to appear and chickenpox caused by Varicella-Zoster virus was suspected. Blood tests showed a strong positivization of viral DNA in the blood. The patient decided to terminate the pregnancy for the fear of congenital chickenpox syndrome. In this case we observed an unexpected viral reactivation to an extent like a first infection although the patient was immune. It is therefore essential to carefully evaluate the administration of Vedolizumab in the first trimester, underlining that a reactivation of the VZV and the manifestation of chickenpox is possible even if the women was cataloged as immune.

References

Baumgart DC, Sandborn WJ. “Crohn’s disease,” 2012, doi: 10.1016/S0140-6736(12)60026-9.

Ordás I, Eckmann L, Talamini M, Baumgart DC, Sandborn WJ. “Ulcerative colitis,” 2012, doi: 10.1016/S0140-6736(12)60150-0.

Van Der Woude CJ, et al. “The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease,” J. Crohn’s Colitis, 2015. doi: 10.1093/ecco-jcc/jju006.

BB et al. “Vedolizumab outcomes in real-world bio-naive ulcerative colitis and crohn’s disease patients (evolve) in Canada: Treatment patterns, clinical effectiveness and safety,” United Eur. Gastroenterol. J., 2018.

Gisbert JP, Domènech E. “Vedolizumab en el tratamiento de la enfermedad de Crohn,” Gastroenterol. Hepatol., 2015. doi: 10.1016/j.gastrohep.2014.12.003.

Mahadevan U, Matro R. “Care of the Pregnant Patient with Inflammatory Bowel Disease,” Obstet. Gynecol., 2015. doi: 10.1097/AOG.0000000000000978.

“Vedolizumab (Entyvio) for inflammatory bowel disease,” Med. Lett. Drugs Ther., 2014.

Toruner M, et al. “Risk Factors for Opportunistic Infections in Patients with Inflammatory Bowel Disease,” Gastroenterology, 2008. doi: 10.1053/j.gastro.2008.01.012.

Fries W, Cottone M, Cascio A. “Systematic review: Macrophage activation syndrome in inflammatory bowel disease,” Alimentary Pharmacology and Therapeutics, 2013. doi: 10.1111/apt.12305.

Cascio A, Iaria C, Ruggeri P, Fries W. “Cytomegalovirus pneumonia in patients with inflammatory bowel disease: A systematic review,” International Journal of Infectious Diseases, 2012. doi: 10.1016/j.ijid.2012.03.008.

Beaugerie L, et al. “Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study,” Lancet, 2009. doi: 10.1016/S0140-6736(09)61302-7.

Shale MJ, Seow CH, Coffin CS, Kaplan GG, Panaccione R, Ghosh S. “Review article: Chronic viral infection in the anti-tumour necrosis factor therapy era in inflammatory bowel disease,” Alimentary Pharmacology and Therapeutics, 2010, doi: 10.1111/j.1365-2036.2009.04112.x.

Puchner A, Gröchenig HP, Sautner J, Helmy-Bader Y, Juch H, Reinisch S, et al. Immunosuppressives and biologics during pregnancy and lactation: A consensus report issued by the Austrian Societies of Gastroenterology and Hepatology and Rheumatology and Rehabilitation. Wien Klin Wochenschr. 2019;131(1-2):29-44. doi: 10.1007/s00508-019-1448-y. Epub 2019 Jan 14. PMID: 30643992; PMCID: PMC6342891.

Ahn KH, Park YJ, Hong SC, Lee EH, Lee JS, Oh MJ, et al. Congenital varicella syndrome: A systematic review. J Obstet Gynaecol. 2016;36(5):563-6. doi: 10.3109/01443615.2015.1127905. Epub 2016 Mar 10. PMID: 26965725.

Cullen G, Baden RP, Cheifetz AS. Varicella zoster virus infection in inflammatory bowel disease. Inflamm Bowel Dis. 2012;18(12):2392-403. doi: 10.1002/ibd.22950. Epub 2012 Mar 20. PMID: 22434654.

Terjung B, Schmelz R, Ehehalt R, et al. Safety of vedolizumab in the treatment of pregnant women with inflammatory bowel disease: a targeted literature review Therap Adv Gastroenterol. 2020;13 PMID:33149762.

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Published

2023-01-23

How to Cite

[1]
S. Bonassisa, C. I. Aquino, A. Libretti, R. Amadori, V. Remorgida, and D. Surico, “Vedolizumab and chickenpox in immune patient during pregnancy”, J. A. Med. Sci, vol. 3, no. 1, pp. 23–25, Jan. 2023.

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