Biologics exposure during pregnancy and breastfeeding in a psoriasis patient

Abstract

Biologic agents have revolutionized the treatment of psoriasis, and the increasing use of these agents in women of childbearing age raises questions regarding pregnancy safety. We report a case of a woman affected with severe psoriasis, who underwent three pregnancies while exposed to biologic agents. Although immediately dismissed at first pregnancy awareness, first‐trimester exposure occurred, and the course of the pregnancies was carefully monitored. The patient was under adalimumab treatment during her first pregnancy and ustekinumab at her second and third gestation. She had a premature birth at 35 weeks during the first two pregnancies and at 36 weeks during her last pregnancy. All babies were born healthy without congenital anomalies. Furthermore, due to the rapid worsening of her psoriasis, biologics treatment was reintroduced immediately after breastfeeding in the first two occasions, but immediately after delivery in the last pregnancy, with the explicit consent of the patients. There are few data available on biologics treatment safety during pregnancy and breastfeeding, especially regarding ustekinumab. We report our positive experience with the aim of increasing case notifications, facilitate meta‐analysis, and eventual consensus recommendations regarding the use of biologics in special population.

Patients’ demographic and socioeconomic characteristics influence the therapeutic decision-making process in psoriasis

“…It has been hypothesized that women are more likely to believe that they can influence their disease themselves and how manage it [13]. In addition, biological therapies might be considered more dangerous for young women of childbearing age, although teratogenic effects are not associated with biologics [14,15].…”

Transfer of monoclonal antibodies into breastmilk in neurologic and non-neurologic diseases

“…24,[31][32][33] ADA was given during pregnancy in 5 mothers with no adverse pregnancy complications; however, 2 of these infants had measurable ADA at delivery in the cord and 1 day postpartum in serum, respectively. [30][31][32][33] At 3 months of age, ADA was no longer detectable in the infant with measurable levels in cord blood despite breastfeeding after maternal treatment, 31 and another breastfed infant had no measurable concentration in serum at 9 days. 33 Cumulatively, 102 infants were breastfed during maternal ADA treatment; 24 mothers provided breastmilk samples between 1 hour and up to 9 days posttreatment, and ADA was only detectable in 17 of these samples.…”

“…Two case reports and 1 registry prospectively followed a combined 9 pregnancies in 8 mothers treated with ustekinumab (UST) for IBD 24,29 or psoriasis. 30 Across all 3 studies, 8 infants were breastfed during maternal UST treatment. Two studies collected breastmilk from 7 mothers, sampled serially between 1 hour and up to 16 weeks postinfusion; some samples were collected after maintenance infusions.…”

“…Three case reports and 2 prospective registries evaluated a combined 141 pregnancies in women treated with adalimumab (ADA) for psoriasis 30 or IBD. 24,[31][32][33] ADA was given during pregnancy in 5 mothers with no adverse pregnancy complications; however, 2 of these infants had measurable ADA at delivery in the cord and 1 day postpartum in serum, respectively.…”

Psoriasis‐Therapie während Schwangerschaft und Stillzeit

“…Für die Anwendung von Ustekinumab während der Stillzeit liegen nur vereinzelte Fallberichte vor [127, 132, 164]. Von den sechs stillenden Patientinnen mit einer chronisch‐entzündlichen Darmerkrankung, konnte bei vier Patientinnen die Substanz in der Muttermilch nachgewiesen werden.…”