The use of tumor necrosis factor inhibitors during high-risk pregnancies in antiphospholipid syndrome: a clinical report of a patient with concomitant Takayasu arteritis and case-based review

In the field of obstetric antiphospholipid syndrome (APS), studies in mouse models and case reports support the potential benefit of tumor necrosis factor-α inhibitors (TNF-i) in preventing pregnancy loss associated with APS. We present the case of a 36-year-old woman with a diagnosis of Takayasu arteritis who suffered from antiphospholipid antibody (aPL)-related thrombotic microangiopathy/probable catastrophic APS during her first pregnancy and who had a subsequent successful pregnancy while on treatment with certolizumab pegol (CZP), heparin, and low-dose aspirin. The report is followed by the literature review of published cases of APS or aPL-positive pregnancies treated with CZP or other TNF-i. A total of 20 pregnancies, including the one here presented, were reported in high-risk APS patients exposed to TNF-i, showing a favorable outcome in most pregnancies (80% live births, 69% absence of adverse pregnancy outcomes). Despite the limited available evidence, TNF-i could represent a promising option for high-risk patients in obstetric APS.