Certolizumab in pregnancy — SCE Rheumatology MCQ

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HardPregnancy in Rheumatic Disease, Rare ConditionsCertolizumab in pregnancySCE Rheumatology

A 35-year-old woman with severe axial spondyloarthritis is planning pregnancy. She previously flared badly when biologic therapy was stopped. She needs a TNF inhibitor with minimal placental transfer later in pregnancy. TB and hepatitis screening are negative. What is the most appropriate biologic?

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Correct answer: C — Certolizumab pegol

Explanation lettering: C = shown as A · D = shown as C · A = shown as D

Certolizumab pegol is best because certolizumab has minimal Fc-mediated placental transfer and is often preferred when TNF inhibition is required through pregnancy. A is less suitable because belimumab is an SLE drug and not axial SpA therapy; B is less suitable because infliximab has placental transfer particularly later in pregnancy; C is less suitable because secukinumab has less pregnancy safety experience than TNF inhibitors; E is less suitable because rituximab is not a standard axial SpA biologic and depletes B cells. Clinical pearl: drug structure matters in pregnancy pharmacology, not just drug class.

Reference: BSR pregnancy and breastfeeding guideline 2022; NICE NG65