BENEFITS OF A “PUMP-AND-DUMP” BREASTFEEDING STRATEGY FOR AN INFANT OF A NURSING MOTHER RECEIVING INTRAVITREAL RANIBIZUMAB

Purpose: To assess the safety of a “pump-and-dump” breastfeeding strategy following intravitreal ranibizumab in a nursing mother. Methods: Pilot study included one treatment-naïve nursing mother (patient A) requiring intravitreal ranibizumab, her newborn (patient B), and four age-matched infant controls. Patient A received ranibizumab 4 days postpartum in the right eye and 1 week later in the left eye. Breastmilk was pumped and discarded for 3 days after each injection, after which breastfeeding was resumed. Breastmilk samples from patient A and blood samples from patient B and controls were collected and measured for ranibizumab and vascular endothelial growth factor-A levels. Results: Ranibizumab was undetectable in patient B and controls. Vascular endothelial growth factor-A levels in patient B were below the lower limit of quantification (LLOQ) at baseline and then remained at low but detectable levels at other time points once breastfeeding had been resumed, which were similar to vascular endothelial growth factor-A levels in controls. Breastmilk ranibizumab levels remained below the LLOQ, and decreasing vascular endothelial growth factor-A levels were observed from baseline (5,266 pg/mL) to Day 4 (1,626 pg/mL), with fluctuating levels thereafter. Conclusion: Ranibizumab was undetectable with no apparent vascular endothelial growth factor-A suppression in the infant of a nursing mother who received intravitreal ranibizumab and breastfed after a 3-day “pump-and-dump” strategy.