Use of Two Biologics During Pregnancy: Infliximab and Vedolizumab: A Case Study
5 affiliations
- 1Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- 2Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- 3Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- 4Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; and
- 5Department of Gynaecology and Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Abstract
Background:: Pregnancy is associated with altered pharmacokinetics for several drugs.
The blood concentration of infliximab increases during pregnancy, whereas that of vedolizumab tends to decrease. As autoimmune disease activity during pregnancy can lead to adverse pregnancy outcomes, monitoring drug concentrations during pregnancy is important.
Methods:: This study reports a 32-year-old female patient with severe juvenile idiopathic arthritis and Crohn disease who was treated with dual biologic therapy throughout her pregnancy. The measurements were performed as part of routine care.
Results:: The patient was treated with vedolizumab and infliximab during the course of her pregnancy. Both autoimmune diseases remained unaffected throughout pregnancy, and therapeutic drug concentrations were monitored to guide treatment. The patient had gestational diabetes and mild polyhydramnios. Ultimately, the pregnancy was complicated by preterm delivery at 33 weeks and 5 days of gestation, with a good birth weight of 2425 g at p85 without growth retardation.
Conclusions:: Therapeutic drug monitoring (TDM) supports optimal dosing and effective disease control, highlighting the importance of individual interpretations. All TDM-initiated dosing changes were based on expert opinions, owing to the lack of validated guidelines on dosing during pregnancy. However, preterm birth could not be avoided and may be influenced by underlying autoimmune diseases, gestational diabetes, and mild polyhydramnios. Multidisciplinary care is essential in pregnant women with autoimmune disorders. Prospective research focusing on drug concentrations, disease activity, and the risk of adverse pregnancy outcomes is needed to understand the safety and implications of dual biologic therapies during pregnancy.
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BibTeX
@article{hoekstra2026biologics,
title = {{Use of Two Biologics During Pregnancy: Infliximab and Vedolizumab: A Case Study}},
author = {Birgit Hoekstra and Dianne G. Bouwknegt and Paola Mian and Gerard Dijkstra and Martha K. Leijsma and Mariëtte Groenewout and Marijn C. Visschedijk},
journal = {Therapeutic Drug Monitoring},
year = {2026},
month = sep,
doi = {10.1097/ftd.0000000000001519},
url = {https://doi.org/10.1097/ftd.0000000000001519},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Use of Two Biologics During Pregnancy: Infliximab and Vedolizumab: A Case Study
AU - Birgit Hoekstra
AU - Dianne G. Bouwknegt
AU - Paola Mian
AU - Gerard Dijkstra
AU - Martha K. Leijsma
AU - Mariëtte Groenewout
AU - Marijn C. Visschedijk
PY - 2026
DA - 2026/09/23
JO - Therapeutic Drug Monitoring
DO - 10.1097/ftd.0000000000001519
UR - https://doi.org/10.1097/ftd.0000000000001519
AB - Background:: Pregnancy is associated with altered pharmacokinetics for several drugs. The blood concentration of infliximab increases during pregnancy, whereas that of vedolizumab tends to decrease. As autoimmune disease activity during pregnancy can lead to adverse pregnancy outcomes, monitoring drug concentrations during pregnancy is important. Methods:: This study reports a 32-year-old female patient with severe juvenile idiopathic arthritis and Crohn disease who was treated with dual biologic therapy throughout her pregnancy. The measurements were performed as part of routine care. Results:: The patient was treated with vedolizumab and infliximab during the course of her pregnancy. Both autoimmune diseases remained unaffected throughout pregnancy, and therapeutic drug concentrations were monitored to guide treatment. The patient had gestational diabetes and mild polyhydramnios. Ultimately, the pregnancy was complicated by preterm delivery at 33 weeks and 5 days of gestation, with a good birth weight of 2425 g at p85 without growth retardation. Conclusions:: Therapeutic drug monitoring (TDM) supports optimal dosing and effective disease control, highlighting the importance of individual interpretations. All TDM-initiated dosing changes were based on expert opinions, owing to the lack of validated guidelines on dosing during pregnancy. However, preterm birth could not be avoided and may be influenced by underlying autoimmune diseases, gestational diabetes, and mild polyhydramnios. Multidisciplinary care is essential in pregnant women with autoimmune disorders. Prospective research focusing on drug concentrations, disease activity, and the risk of adverse pregnancy outcomes is needed to understand the safety and implications of dual biologic therapies during pregnancy.
SN - 0163-4356
SN - 1536-3694
ER -