Биологическая терапия астмы снижает риски осложнений при беременности

Biologic asthma treatment linked to reduced risks for pregnancy complications Key takeaways: - Risks for poor pregnancy outcomes increase with asthma. - Biologics included omalizumab, dupilumab, benralizumab, mepolizumab and tezepelumab. - Guidelines recommend continued biologics in pregnancy. ORLANDO — Patients with asthma who used biologics during pregnancy had less risk for complications than those who did not, according to a poster presented at the American Thoracic Society International Conference. Prior research has associated asthma with risks for poor outcomes in pregnancy, Bailey Matsumura, student at John Sealy School of Medicine, University of Texas Medical Branch, and colleagues wrote. “We wanted to know that for some of these endpoints — like preeclampsia, preterm labor, preterm birth, postpartum hemorrhage and gestational diabetes, which are more prevalent in asthmatic patients during pregnancy — does the use of biologics decrease these outcomes?” Matsumura told Healio. The researchers used TriNetX to develop two cohorts of 571 patients with asthma who were pregnant. One cohort was treated with omalizumab, dupilumab, benralizumab, mepolizumab or tezepelumab during pregnancy. The other cohort had no exposure to these biologics during their pregnancy or during the previous year. “The most recent pregnancy was used to ensure that endpoints were not being considered for previous pregnancies in which biologics were not being used,” Matsumura said. Prevalence of preeclampsia included 3.633% (n = 19) in the biologic group and 8.989% (n = 48) in the nonbiologic group (RR = 0.404; 95% CI, 0.241-0.678). Similarly, prevalence of postpartum hemorrhage included 2.222% (n = 12) in the biologic group and 4.936% (n = 27) in the nonbiologic group (RR = 0.45, 95% CI, 0.23-0.879. “That’s definitely something that I think is worth continuing to follow,” she said. “Postpartum hemorrhage and bleeding is the leading cause of maternal mortality globally. This data could suggest that biologics to treat severe asthma during pregnancy could potentially decrease this risk of mortality.” Percentages of patients with preterm labor included 2.286% (n = 12) of the biologic group and 7.008% (n = 37) of the nonbiologic group (RR = 0.326; 95% CI, 0.172-0.618). Gestational diabetes was recorded among 2.729% (n = 14) of the biologic group and 6.831% (n = 36) of the nonbiologic group (RR = 0.4; 95% CI, 0.218-0.732). Matsumura said that these findings line up with previous clinical research. “This is definitely something that we need to keep watching,” she said. Matsumura speculated that these improved outcomes with biologic treatment are partly due to increased oxygenation for both the mother and baby, which can decrease stress put on the body during times of poor oxygenation, and therefore the downstream effects associated with poor oxygenation to both mother and fetus. “Studies have demonstrated that poorly controlled asthma and asthma exacerbations result in increased cortisol,” she said. “Cortisol’s effects on insulin resistance are also well developed, so this makes sense why appropriately managed asthma during pregnancy would result in decreased prevalence of gestational diabetes.” These findings also support current recommendations for care, she added. “Current guidelines support the use of biologics during pregnancy if necessary for adequate management of asthma symptoms,” she said. “Our data seems to support these guidelines by suggesting that their use can decrease certain adverse events for asthmatic patients during pregnancy,” she continued. “Our results are retrospective in nature and, ideally, prospective studies would offer us more insight into the complete safety profile of these drugs for both mom and baby.” Noting that TriNetX regularly updates its data, Matsumura said she would like to follow the progression of these findings as more patients are added. “Asthma in itself, and the complications it can cause, is a risk to the safety and health of mom and the baby during pregnancy,” she said. For more information: Bailey Matsumura can be reached at [email protected].