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Traces of anti-VEGF drugs found in breast milk

Anti-vascular endothelial growth factor (anti-VEGF) drugs have been identified in breast milk, prompting warnings from the researchers that the use of these medications during breastfeeding could affect developing infants.

According to a study recently published in the journal Ophthalmology, anti-VEGF drugs ranibizumab and aflibercept were detected in the breast milk of three lactating mothers after receiving injections.

Of the study’s three participants, one continued to breastfeed throughout therapy, while the second discontinued breastfeeding and the third never started. Drugs were found to have been excreted into breast milk in the days following an injection, with a corresponding reduction in VEGF levels detected.

The amount of medication found in the patient who continued to breastfeed was also significantly lower than the study’s other two participants, suggesting the medication was constantly excreted.

Researchers behind the project warned that considering the important role VEGF plays in the development of an infant’s digestive system, the presence of anti-VEGF could lead to developmental issues.

“As retina specialists, we often tell our pregnant or nursing patients that there’s a risk of a small amount of these drugs making its way into the breast milk, but we can’t be sure,” Dr Rajeev Muni, co-lead author of the study and vitreoretinal surgeon at St. Michael’s Hospital in Toronto, Canada, said.

“We don’t want these patients to lose their vision so we make a decision, despite limited information.”

Dr Verena Juncal, co-lead author on the study and retinal fellow at St. Michael’s Hospital, said the results confirm the drug reaches breast milk.

“We realise that some readers may question the small sample size, but if the drug reaches the breast milk in three patients, it’ll reach in 30 patients because it’s the same biological process.”

It is hoped that the findings might assist ophthalmologists and retina specialists when counselling pregnant and nursing patients. The team’s future plans include measuring the levels of the drugs in infant’s blood and measuring long-term exposure.