Doenças inflamatórias do tipo 2: perfil de segurança de imunobiológicos e pequenas moléculas na gestação
Type 2 inflammatory diseases: safety profile of biologics and small molecules during pregnancy
Catarina Monteiro Palumbo; Marcelo Vivolo Aun
Resumo
As doenças inflamatórias crônicas do tipo 2 são altamente prevalentes em mulheres em idade fértil. Quando mal controladas, se associam a complicações gestacionais, o que justifica o estudo de diferentes alternativas para o seu manejo. Esse artigo objetiva revisar a literatura sobre o uso de terapias avançadas, como imunobiológicos e pequenas moléculas, em doenças do tipo 2, com enfoque em seu perfil de segurança durante a gestação. Foram analisados os estudos observacionais disponíveis na literatura de 2010 a 2024, visando avaliar o risco de complicações maternas e fetais advindas da exposição a estas medicações na gestação. Não foram encontrados ensaios clínicos randomizados em humanos sobre o tema. Em nenhum estudo sobre omalizumabe e dupilumabe a exposição foi diretamente associada a desfechos negativos. Não há dados suficientes em humanos para predizer aumento de risco de complicações no uso de mepolizumabe, benralizumabe, tezepelumabe, reslizumabe ou tralokinumabe. Os inibidores das Janus quinase são absolutamente contraindicados após a concepção, pelo risco observado na exposição de animais. São necessários mais estudos sobre o tema, para melhor compreensão da segurança de terapias avançadas na gestação, visando decisões clínicas mais embasadas no futuro.
Palavras-chave
Abstract
Type 2 chronic inflammatory diseases are highly prevalent among women of childbearing age. When poorly controlled, they are associated with pregnancy complications, which justifies the study of different options for their management. This study aimed to review the literature on the use of advanced therapies, such as biologics and small molecules, for type 2 diseases, focusing on their safety profile during pregnancy. Observational studies available in the literature from 2010 to 2024 were analyzed to determine the risk of maternal and fetal complications arising from exposure to these medications during pregnancy. No randomized clinical trials involving human participants were found on the topic. No study showed a direct association between exposure to omalizumab or dupilumab and negative outcomes. There is insufficient evidence in humans to predict increased risk of complications with the use of mepolizumab, benralizumab, tezepelumab, reslizumab, or tralokinumab. Janus kinase inhibitors are absolutely contraindicated after conception due to risks observed in animal studies. Further research is needed to better understand the safety of advanced therapies during pregnancy, with the goal of making more informed clinical decisions in the future.
Keywords
Referências
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Submetido em:
17/09/2024
Aceito em:
26/10/2026
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