A Case Series of Patients With Psoriasis Exposed to Biologic Therapy During Pregnancy: The BIOBADADERM Register and a Review of the Literature

Echeverría-García, B.; Nuño-González, Almudena; Daudén, E.; Vanaclocha, F.; Torrado, R.; Belinchón, I.; Pérez-Zafrilla, Beatriz

doi:10.1016/j.adengl.2016.12.015

Cited by 6 publications

(10 citation statements)

References 9 publications

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“…In that report, 10 patients with psoriasis were treated with biologic therapy during gestation: 6 received ustekinumab, 1 received ADA, and 1 received ETN during the initial weeks of pregnancy, and 2 received IFX throughout their pregnancies. All but 2 patients had a normal pregnancy and delivery: 1 had a spontaneous abortion and the newborn of another was a collodion baby whose skin normalized over a period of 2 months 12 .…”

Section: Discussionmentioning

confidence: 99%

The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis

Berman

Zisman²,

Wollman³

et al. 2018

J Rheumatol

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Section: Discussionmentioning

confidence: 99%

The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis

Berman

Zisman²,

Wollman³

et al. 2018

J Rheumatol

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“…There are only five published case series (including ≥3 patients) addressing pregnancy outcomes in women with psoriasis exposed to biologic therapies ( Table 2). 33 respiratory distress in the newborn and detachment of the amniotic sac, 34 were reported in three pregnancies.…”

Section: Discussionmentioning

confidence: 96%

“…Overall, 41 babies 33-37 -including two pairs of twins 33,35 -were born without congenital abnormalities. Other pregnancy outcomes included three elective abortions 34,37 and three miscarriages, 36,37 whereas two pregnancies were still in progress. 33,37 Potential long-term risks of in utero exposure to biologic therapies include severe infections, immunological and hematological abnormalities, atopy, allergies, and malignancies-especially lymphoid cancers.…”

Section: Discussionmentioning

confidence: 99%

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Use of biologic therapies for psoriasis during pregnancy and long‐term outcomes of exposed children: A 14‐year real‐life experience at a tertiary center in Turkey and review of the literature

Kobaner

Ekinci

2020

Dermatologic Therapy

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Data regarding the use of biologic therapies for psoriasis during pregnancy are scarce with even more limited knowledge about the long-term safety of in utero exposure. We retrospectively evaluated nine pregnancies in six women with psoriasis who were exposed to biologic therapies between 2006 and 2019 in our psoriasis clinic, a tertiary referral center in Turkey. Pregnancy outcomes included the delivery of seven healthy babies without any complications, one elective abortion, and one ectopic pregnancy. All exposed children, aged between 14 months and 13 years (median age: 4.0 years), showed normal growth and neuropsychological development without immunodeficiencies, allergies, malignancies or other diseases. Based on up-to-date collective data in the literature and our real-life clinical experience presented here, exposure to biologic therapies during pregnancy for psoriasis does not seem to be associated with adverse pregnancy or neonatal outcomes. Our results are also reassuring with respect to long-term outcomes of exposed children, but need to be confirmed through further large prospective studies. Nevertheless, use of biologic therapies during late pregnancy, particularly during the third trimester, should be reserved for high-need patients with psoriasis and definitely requires a delicate risk/ benefit balance on a case-by-case basis. K E Y W O R D S biologic therapies, exposed children, in utero exposure, long-term outcomes, pregnancy, psoriasis, therapy-systemic 1 | INTRODUCTION Psoriasis is a chronic immune-mediated inflammatory disease that usually appears at early adulthood, even onset before the age of 40 years accounts for approximately 75% of all cases. Given that female-to-male distribution in psoriasis is nearly equal, most women with psoriasis are of childbearing potential. 1,2 The course of psoriasis during pregnancy is unpredictable, 3 varies from case to case. In a questionnaire-based study that included 90 patients, 63.3% reported improvement during pregnancy, whereas 87.7% had a postpartum flare, particularly within 4 months of delivery. 4 In a retrospective study evaluating 91 pregnancies, psoriasis showed improvement in 56%, worsening in 26.4%, and no change in 17.6% of cases. 5 New lesions frequently appeared during the early postpartum period. The patients who improved in the first pregnancy reported a similar response in subsequent ones. 5 In a controlled study of 47 patients, during pregnancy, improvement, no change and worsening in psoriasis were observed in 55%, 21%, and 23% of patients,

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“…Case studies involving infliximab, 31 adalimumab, and ustekinumab 32 have demonstrated that healthy babies have been born after maternal exposure to biologics. Additionally, case series involving etanercept, adalimumab, and ustekinumab 33 and ustekinumab alone 34 have demonstrated that most pregnancies and deliveries proceed without complications. Pregnancy exposure registries, such as the Organization of Teratology Information Specialists (OTIS)/MotherToBaby in the United States and Canada (https:// mothertobaby.…”

Section: Human Datamentioning

confidence: 99%

Management of Plaque Psoriasis With Biologic Therapies in Women of Child-Bearing Potential Consensus Paper

et al. 2020

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Background Plaque psoriasis (PsO) is a chronic inflammatory disease that often presents at peak reproductive age in women of child-bearing potential (WOCBP). With the emergence of biologic therapies to treat PsO, guidance on disease management in WOCBP is needed to inform treatment decisions before, during, and after pregnancy. Objectives To develop a practical, up-to-date consensus document, based on available evidence and expert opinion where evidence was lacking, in order to guide both Canadian and international clinicians treating PsO in WOCBP. Methods A panel of 9 Canadian dermatologists with extensive clinical experience managing PsO reviewed the relevant literature from the past 25 years in 3 key domains: overview of PsO in WOCBP and clinical considerations, treatment considerations, and postpartum considerations. The structured literature search focused on WOCBP treated with TNF-alpha inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), IL-12/23 inhibitors (ustekinumab), and IL-17 inhibitors (brodalumab, ixekizumab, secukinumab). This literature review, along with clinical expertise and opinion, was used to develop concise and clinically relevant consensus statements to guide practical management of PsO in WOCBP. Experts voted on the statements using a modified Delphi process and prespecified agreement cut-off of 75%. Results and implications After review, discussion, and voting on 19 draft consensus statements at an in-person meeting and remotely, 12 consensus statements were approved by the expert panel. The statements presented here will guide healthcare providers in practical disease management using biologic therapies for the treatment of PsO in WOCBP.

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A Case Series of Patients With Psoriasis Exposed to Biologic Therapy During Pregnancy: The BIOBADADERM Register and a Review of the Literature

Cited by 6 publications

References 9 publications

The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis

The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis

Use of biologic therapies for psoriasis during pregnancy and long‐term outcomes of exposed children: A 14‐year real‐life experience at a tertiary center in Turkey and review of the literature

Management of Plaque Psoriasis With Biologic Therapies in Women of Child-Bearing Potential Consensus Paper

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