Vedolizumab (Entyvio®)

Selected References:

  • Barrau M, et al. 2023. What Should We Know about Drug Levels and Therapeutic Drug Monitoring during Pregnancy and Breastfeeding in Inflammatory Bowel Disease under Biologic Therapy?. J Clin Med. 12(23):7495.
  • Bell C, et al. 2021. Systematic review and meta-analysis: Safety of vedolizumab during pregnancy in patients with inflammatory bowel disease. J Gastroenterol Hepatol;36(10):2640-2648. PMID: 34110640 DOI: 10.1111/jgh.15574
  • Caballero-Mateos AM, et al. 2023. IBD and Motherhood: A Journey through Conception, Pregnancy and Beyond. J Clin Med. 12(19):6192.
  • Chugh R. 2023. Maternal and Neonatal Outcomes in Vedolizumab and Ustekinumab Exposed Pregnancies: Results from the PIANO registry. Am J Gastroenterol. DOI: 10.14309/ajg.0000000000002553.
  • Ding N, et al. 2022. Management of biologics in pregnant, lactating patients with inflammatory bowel disease and the impact on neonatal vaccination: A systematic review of clinical practice guidelines and consensus statements. J Clin Pharm Ther. 47(12):1952-1965.
  • Gisbert JP, et al. 2023. Vaccines in Children Exposed to Biological Agents In Utero and/or During Breastfeeding: Are They Effective and Safe?. J Crohns Colitis. 17 (6):995-1009.
  • Gisbert JP, et al. 2020. Safety of New Biologics (Vedolizumab and Ustekinumab) and Small Molecules (Tofacitinib) During Pregnancy: A Review. Drugs;80(11):1085-1100. PMID: 32562207 DOI: 10.1007/s40265-020-01346-4
  • Honap S, et al. 2023. An update on the safety of long-term vedolizumab use in inflammatory bowel disease. Expert Opin Drug Saf. 22 (9):767-776.
  • Julsgaard M, et al. 2017. Vedolizumab safety in pregnancy and newborn outcomes. Gut; 66(10):1866-1867.
  • Julsgaard M, et al. 2018. Vedolizumab concentrations in the breast milk of nursing mothers with inflammatory bowel disease. Gastroenterology 154: 752-765.
  • Lahat A, et al. 2018. Vedolizumab levels in breast milk of nursing mothers with inflammatory bowel disease. J Crohns Colitis; 12:120-3.
  • Lamb CA, et al. 2019. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut ;68(Suppl 3):s1-s106. PMID: 31562236 PMCID: PMC6872448 DOI: 10.1136/gutjnl-2019-318484
  • Laube R, et al. 2021. Use of medications during pregnancy and breastfeeding for Crohn’s disease and ulcerative colitis. Expert Opin Drug Saf ;20(3):275-292. PMID: 33412078 DOI: 10.1080/14740338.2021.1873948
  • Mahadevan U, et al. 2017. Vedolizumab exposure in pregnancy: Outcomes from clinical studies in inflammatory bowel disease. Aliment Pharmacol Ther; 45:941-950.
  • Mahadevan U, et al. 2017. Editorial: vedolizumab in pregnancy – is gut selectivity as good for baby as it is for mum? Authors’ reply. Aliment Pharmacol Ther. 45(9):1284.
  • Meyer A, et al. 2024. Safety of Vedolizumab and Ustekinumab Compared With Anti-TNF in Pregnant Women With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. DOI: 10.1016/j.cgh.2023.12.029.
  • Mitrova K, et al. 2022. Safety of Ustekinumab and Vedolizumab During Pregnancy-Pregnancy, Neonatal, and Infant Outcome: A Prospective Multicentre Study. Journal of Crohn’s & colitis. Vol 16, 12: 1808-1815.
  • Moens A, et al. 2019. Outcome of pregnancies in female patients with inflammatory bowel diseases treated with vedolizumab. J Crohns Colitis 13(1): 12-13.
  • Moens A, et al. 2020. Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study. Aliment Pharmacol Ther 51(1): 129-138.
  • Nielsen OH. 2022. Biologics for Inflammatory Bowel Disease and Their Safety in Pregnancy: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 20(1):74-87.
  • Pugliese D, et al. 2024. New drugs for the treatment of IBD during conception, pregnancy, and lactation. Dig Liver Dis. 56 (2): 235-241.
  • Rosario M, et al. 2017. A Review of the Clinical Pharmacokinetics, Pharmacodynamics, and Immunogenicity of Vedolizumab. Clin Pharmacokinet. 2017; 56(11): 1287–1301. PMCID: PMC5648740 PMID: 28523450
  • Sheridan J, et al. 2017. Letter: Vedolizumab in Pregnancy. J Crohns Colitis; 11(8):1025-1026.
  • Shitrit AB-G A, et al. 2019. Exposure to vedolizumab in IBD pregnant women appears of low risk for mother and neonate: A first perspective comparison study. Am J Gastroenterol 114(7): 1172-1175.
  • Sun W, et al. 2021. Vedolizumab concentrations in breast milk: Results from a prospective, postmarketing, milk-only lactation study in nursing mothers with inflammatory bowel disease. Clin Pharmacokinet. 60:811-8.
  • Takeda Pharmaceuticals America, Inc. 2018. Entyvio product label. Available at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6e94621c-1a95-4af9-98d1-52b9e6f1949c


Vedolizumab (Entyvio®)

Selected References:

  • Andrade C. 2020. Major Congenital Malformation Risk After First Trimester Gestational Exposure to Oral or Intravenous Ondansetron. J Clin Psychiatry;81(3):20f13472
  • Anderka M, et al. 2012. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Res A Clin Mol Teratol; 94(1):22–30.
  • Briggs GG, Freeman RK. 2014. Drugs in Pregnancy and Lactation. 10th edition. Philadelphia, PA: Wolters Kluwer (online version).
  • Kaplan YC, et al. 2019. Use of ondansetron during pregnancy and the risk of major congenital malformations: A systemic review and meta-analysis. Reprod Toxicol; 86 Jun:1-13.
  • Cao X, et al. 2022. Risk of abnormal pregnancy outcomes after using ondansetron during pregnancy: A systematic review and meta-analysis. Front Pharmacol, 13(951072).
  • Cohen R, et al. 2014. Intestinal obstruction in pregnancy by ondansetron. Reprod Toxicol. 2014 Oct 24;50C:152-153.
  • Colvin L, et al. 2013. Off-label use of ondansetron in pregnancy in Western Australia. Biomed Res Int. 2013:909860.
  • Danielsson B, Wikner BN, Kallen B. 2014. Use of ondansetron during pregnancy and congenital malformations in the infant. Reprod Toxicol 50:134-7.
  • Diav-Citrin O, et al. 2017. Pregnancy outcome following in utero exposure to ondansetron: A prospective comparative, observational cohort study. Reprod Toxicol; 72:203.
  • Dormuth CR, et al; Canadian Network for Observational Drug Effect Studies (CNODES) Investigators. 2021. Comparison of Pregnancy Outcomes of Patients Treated with Ondansetron vs Alternative Antiemetic Medications in a Multinational, Population-Based Cohort. JAMA Netw Open; 4(4):e215329.
  • Einarson AK, et al. 2004. The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG;111:940-3.
  • Elkomy MH, et al. 2015. Ondansetron pharmacokinetics in pregnant women and neonates: towards a new treatment for neonatal abstinence syndrome. Clin Pharmacol Ther. 97:167-76.
  • Fejzo MS, et al. 2016. Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States. Reprod Toxicol 62: 87-91.
  • Food and Drug Administration. 2012. FDA Drug Safety Communication: New information regarding QT prolongation with ondansetron (Zofran). https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-new-information-regarding-qt-prolongation-ondansetron-zofran. Accessed 2018 & 2022.
  • Jelting Y, et al. 2017. Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: Challenges and solutions. Local Reg Anesth, 10:83–90.
  • Larrimer MB, et al. 2014. Antiemetic medications in pregnancy: a prospective investigation of obstetric and neurobehavioral outcomes. Am J Obstet Gynecol 210 (3): 270. e1-7
  • Lavecchia M, et al. 2018. Ondansetron in Pregnancy and the Risk of Congenital Malformations: A Systematic Review. J Obstet Gynaecol Can. 40(7):910-918.
  • Lemon LS, et al. 2020. Ondansetron use in the first trimester of pregnancy and the risk of neonatal ventricular septal defect. Int J Epidemiol;49(2):648-656.
  • Masarwe S, et al. 2023. Ondansetron use during pregnancy: Birth defects and obstetric outcomes. Clin Nurs Res, 32(4):705-711.
  • Pasternak B. 2013. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med 368:814-823.
  • Picot C, et al. 2020. Risk of malformation after ondansetron in pregnancy: An updated systemic review and meta-analysis. Birth Defects Res;112(13):996-1013.
  • Reis ACC, et al. 2023. Safety evaluation of ondanstron after gestational exposure on male reproductive parameters in rats. Regul Toxicol Pharmacol, 137:105302.
  • Sakran R, et al. 2021. Pregnancy outcome following in-utero exposure to ondansetron: A prospective comparative observational study. Reprod Toxicol; 99:9-14.
  • Schrager NL, et al. 2023. The association of nausea and vomiting of pregnancy, its treatments, and select birth defects: Findings from the National Birth Defect Prevention Study. Birth Defects Res, 115(3):275-289.
  • Suarez EA, et al. 2021. Ondansetron use in early pregnancy and the risk of late pregnancy outcomes. Pharmacoepidemiol Drug Saf; 30(2):114-125.
  • Suarez EA, et al. 2021. Ondansetron use in early pregnancy and the risk of miscarriage. Pharmacoepidemiol Drug Saf; 30(2):103-113.
  • Zhao W, et al. 2020. Retrospective comparison of the safety and effectiveness of dexmedetomidine versus standard of care before and during cesarean delivery in a maternity unit in Zhengzhou, China. Med Sci Monit, 26:e925709.


Vedolizumab (Entyvio®)

Selected References:

  • Andersen, J. B, et al. 2023. Pregnancy outcomes after early fetal exposure to injectable first-line treatments, dimethyl fumarate, or natalizumab in Danish women with multiple sclerosis. European journal of neurology, 30(1), 162–171.
  • Ciplea, A. I, et al. 2020. Exposure to natalizumab during pregnancy and lactation is safe – Commentary. Multiple sclerosis (Houndmills, Basingstoke, England), 26(8), 892–893.
  • D’Amico, E, et al. 2021. Male fertility in relapsing-remitting multiple sclerosis patients treated with natalizumab and ocrelizumab: A prospective case-control study. Multiple sclerosis (Houndmills, Basingstoke, England), 27(14), 2284–2287.
  • Ebrahimi N, et al. 2014. Pregnancy and fetal outcomes following natalizumab exposure in pregnancy. A prospective, controlled observational study. Mult Scler. 2015 Feb;21(2):198-205.
  • Friend S, et al. 2016. Evaluation of pregnancy outcomes from the Tysabri (natalizumab) pregnancy exposure registry: a global, observational, follow-up study. BMC Neurol. Aug 24;16(1):150
  • Gklinos, P, et al. 2023. Monoclonal Antibodies in Pregnancy and Breastfeeding in Patients with Multiple Sclerosis: A Review and an Updated Clinical Guide.Pharmaceuticals (Basel, Switzerland),16(5), 770.
  • Haghikia A, , et al. 2014. Natalizumab use during the third trimester of pregnancy. JAMA Neurol 71(7): 891-895.
  • Mahadevan U, , et al. 2019. Inflammatory bowel disease in pregnancy clinical care pathway: a report from the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology. Apr;156(5):1508-1524.
  • Massarotti, C., et al. 2021. Effect of Multiple Sclerosis and Its Treatments on Male Fertility: Cues for Future Research. Journal of clinical medicine, 10(22), 5401
  • O’Leary, S, et al. 2023. Practical Clinical Guidelines for Natalizumab Treatment in Patients With Relapsing Multiple Sclerosis. Journal of infusion nursing : the official publication of the Infusion Nurses Society, 46(6), 347–359.
  • Oreja-Guevara, C, et al. 2023. Family Planning in Fertile-Age Patients With Multiple Sclerosis (MS) (ConPlanEM Study): Delphi Consensus Statements. Cureus, 15(8), e44056
  • Peng A, et al. 2018. Natalizumab exposure during pregnancy in multiple sclerosis: a systematic review. J Neurol Sci. 2019 Jan 15;396:202-205.
  • Portaccio E, et al. 2018. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab. I: Fetal risks. Neurology. Page #s or journal volume?
  • Simone, I. L, et al. 2021. Influence of Pregnancy in Multiple Sclerosis and Impact of Disease-Modifying Therapies.Frontiers in neurology,12, 697974.
  • Tysabri. Drug Approval Package. Pharmacology reviews. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2004/125104s000_natalizumab.cfm
  • Ramesh, V, et al. 2022. Adverse Obstetric Outcomes in Pregnant Women Using Natalizumab for the Treatment of Multiple Sclerosis: A Systematic Review. Cureus,14(10), e29952


Vedolizumab (Entyvio®)

Selected References:

  • Benyamini L, et al. 2005. The safety of amoxicillin/clavulanic acid and cefuroxime during lactation. Ther Drug Monit. 27:499–502.
  • Chu YN, et al. 2019. Toxic epidermal necrolysis in an infant induced by drug intake through breast milk. Dermatologica Sinica. 37:86–89.
  • Czeizel AE, et al. 2001. Use of cephalosporins during pregnancy and in the presence of congenital anomalies: a population-based, case-control study. Am J Obstet Gynecol 184:1289-1896.
  • Ilett KF, et al. 2006. Transfer of probenecid and cephalexin into breast milk. Ann Pharmacother. 40:986–989.
  • Ito S, et al. 1993. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 168:1393–1399.
  • Kafetzi D, et al. 1981. Passage of cephalosporins and amoxicillin into the breast milk. Acta Paediatr Scand 70:285-288.
  • Teva Pharmaceuticals. 2020. Cephalexin product label. Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=19307ff0-71de-477b-965d-ea243e5ede3a. [Accessed March 27 2024]


Vedolizumab (Entyvio®)

Selected References:

  • Anghelache M, et al. 2022. Multiple sclerosis in pregnancy- current neurological considerations. Romanian Journal of Pediatrics, 71(2):55-59.
  • Novartis Pharmaceuticals Corporation. 2022. Mayzent Drug Label, Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=44492772-5aed-4627-bd85-e8e89f308bb3
  • Ruggieri S, et al. 2022. Ponesimod in the treatment of relapsing forms of multiple sclerosis: a update on the emerging clinical data. Degenerative Neurological and Neuromuscular Disease, 12:61-73.
  • Sabsabi S, et al. 2023. Clinical evaluation of siponimod for the treatment of secondary progressive multiple sclerosis: pathophysiology, efficacy, safety, patient acceptability, and adherence. Patient Preference and Adherence, 16:1307–1319.