From the Guidelines
Women of childbearing age taking Orencia (abatacept) who are planning pregnancy should not switch to Cimzia (certolizumab pegol) without consulting their rheumatologist, as the current evidence does not support a clear recommendation for switching due to pregnancy plans alone. When considering pregnancy, it's essential to weigh the risks and benefits of any medication. According to the British Association of Dermatologists' guidelines for biologic interventions for psoriasis 2009 1, biologic agents should be avoided in patients planning pregnancy, and effective contraception is strongly recommended to prevent pregnancy in women of child-bearing potential.
The guidelines suggest that patients who are established on biologic agents and discover they are pregnant should be referred to a specialist fetal medicine unit for further assessment, and consideration should be given to stopping biologic therapy 1. However, the decision to switch or stop biologic therapy should be made on a case-by-case basis, balancing the risks to the mother of stopping biologic therapy against any potential harm to the fetus/infant 1.
While Cimzia (certolizumab pegol) has a unique structure that may minimize placental transfer, the available evidence does not provide a clear recommendation for switching from Orencia to Cimzia solely for pregnancy planning. Any medication change should be individualized based on the woman's specific condition, disease activity, and pregnancy plans under medical supervision. The primary concern should be to control maternal autoimmune disease while minimizing potential risks to the developing fetus, and this should be achieved through a thorough discussion with a rheumatologist.
From the FDA Drug Label
are pregnant or plan to become pregnant. It is not known if ORENCIA can harm your unborn baby. If you took ORENCIA during pregnancy, talk to your healthcare provider before your baby receives any vaccines are pregnant or plan to become pregnant. You and your doctor should decide if you should continue to take CIMZIA while you are pregnant. It is not known if CIMZIA will harm your unborn baby.
The decision to switch from Orencia (abatacept) to Cimzia (certolizumab pegol) for women of childbearing age who want to get pregnant should be made on a case-by-case basis. Both drugs have similar warnings regarding pregnancy, stating that it is not known if they can harm the unborn baby. No conclusive evidence is available to recommend switching from one drug to the other solely based on pregnancy plans. It is essential to consult a healthcare provider to discuss the potential risks and benefits of each medication and make an informed decision.
From the Research
Medication Considerations for Women of Childbearing Age
When considering pregnancy, women taking Orencia (abatacept) may wonder if switching to Cimzia (certolizumab pegol) is advisable. The following points summarize the relevant information:
- Safety of Abatacept: According to 2, pregnancy data for abatacept are limited, and its use in pregnancy cannot currently be recommended.
- Safety of Certolizumab Pegol: As stated in 3, certolizumab is considered the drug of choice throughout pregnancy and lactation among anti-TNF biological therapies, which are deemed low risk.
- General Considerations for Biological Medications: 2 suggests that exposure to anti-TNF therapies at conception and/or during pregnancy is not associated with adverse pregnancy outcomes or any increase in congenital abnormalities. However, the long-term effects on children exposed to these drugs in utero remain unknown.
- Switching Medications: Given the limited data on abatacept's safety during pregnancy and the more favorable profile of certolizumab pegol, switching from Orencia to Cimzia might be considered for women of childbearing age planning to become pregnant, as indicated by 3.
Key Points for Decision-Making
- The lack of comprehensive data on many biological and immunosuppressive medications during pregnancy necessitates cautious decision-making 3, 2.
- Pregnancy planning is crucial for selecting the safest drug regimen, especially when chronic treatments with teratogenic potential are involved 3.
- Topical medications, in general, have limited systemic absorption and are considered safer than oral or parenteral agents during pregnancy 4, 5. However, this does not directly apply to the comparison between Orencia and Cimzia, as both are not topical agents.