Management of Psoriasis During Preconception, Pregnancy, Postpartum, and Breastfeeding: A Consensus Statement

Belinchón, I.; Velasco, María; Ara‐Martín, Mariano; Alonso, Selena; Rodríguez, Ofelia Baniandrés; Pulido, Laura; García‐Bustínduy, M.; Martínez-López, Juan Antonio; Sánchez, Núria Martínez; Ferriols, Amparo Pérez; Pascual, Eliseo; Díaz, Raquel Rivera; Ruiz‐Villaverde, Ricardo; Ferrer, Rosa Taberner; Villa, Asunción Vicente; Carrascosa, J.M.

doi:10.1016/j.adengl.2020.10.031

Cited by 7 publications

(16 citation statements)

References 91 publications

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“…IgG1 (adalimumab, infliximab, secukinumab, ustekinumab, guselkumab, risankizumab, tildrakizumab, and bimekizumab) is considered the most easily transported subtype, followed by IgG4 (ixekizumab), IgG3, and IgG2 (brodalumab) 58 . Exceptions include etanercept, a fusion protein with low affinity, and certolizumab pegol, a pegylated human IgG1 monoclonal antibody with reduced or no placental transfer due to the absence of an Fc receptor 60–62 …”

Section: Discussionmentioning

confidence: 99%

“…58 Fetal IgG blood in the umbilical vein do not exceed maternal levels until the third trimester (around the 22nd gestational week), when active placental transport increases rapidly, facilitated by neonatal Fc receptors on the syncytiotrophoblast. 59 Thus, exposure to biologic agents in late pregnancy is associated with elevated cord blood drug levels and may result in therapeutic fetal levels of monoclonal antibodies. 59,60 However, our study shows that most fetal exposure (72.4%) occurs exclusively during the first trimester.…”

Section: Pregnancy Outcomes Amentioning

confidence: 99%

“…59 Thus, exposure to biologic agents in late pregnancy is associated with elevated cord blood drug levels and may result in therapeutic fetal levels of monoclonal antibodies. 59,60 However, our study shows that most fetal exposure (72.4%) occurs exclusively during the first trimester. This fact could limit the generalizability of the results, as data on fetal complications in pregnancies exposed to biologics during the last trimesters are scarce.…”

Section: Pregnancy Outcomes Amentioning

confidence: 99%

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Exposure to biologic therapy before and during pregnancy in patients with psoriasis: Systematic review and meta‐analysis

Sánchez‐García,

Hernández‐Quiles,

de‐Miguel‐Balsa

et al. 2023

Acad Dermatol Venereol

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Biologicals have transformed the management of severe disease phenotypes in psoriasis and are often prescribed in women of childbearing age. However, information on safety of biologicals in pregnancy are lacking. We conducted a systematic review and meta‐analysis aimed to describe the characteristics and pregnancy outcomes in women with psoriasis exposed to biologics within 3 months before or during pregnancy, and to estimate the pooled prevalence of spontaneous, elective and total abortions, and congenital malformations in their newborns. Bibliographic searches were performed in the PubMed, Embase, Scopus and Web of Science databases up to 14 April 2022. No restrictions on sample size or publication date were applied. Review performance complied with PRISMA guidelines, and two reviewers assessed randomized controlled trials and nonrandomized studies reporting pregnancy outcomes in women exposed to biologics indicated for psoriasis during the pre‐gestational and/or gestational period. Studies focusing on rheumatologic or gastroenterological immune‐mediated inflammatory diseases were excluded. Regardless of data heterogeneity, a random‐effects model was used to pool prevalence estimates. We included 51 observational studies, involving 739 pregnancies exposed to approved biologics for psoriasis. Administration was mostly (70.4%) limited to the first trimester, and the most common drug was ustekinumab (36.0%). The estimated prevalence of miscarriage was 15.3% (95% confidence interval [CI] 12.7–18.0) and elective abortions, 10.8% (95% CI 7.7–14.3). Congenital malformations occurred in about 3.0% (95% CI 1.6–4.8) of live births exposed to biologics during pregnancy. Altogether, exposure to biologics for psoriasis during pregnancy and/or conception does not seem to be associated with an increased risk of miscarriage/abortion or congenital malformations, showing similar rates to the general population. These results suggest that biologic drugs are safe and pose an acceptable risk to the foetuses/neonates.

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Section: Discussionmentioning

confidence: 99%

Section: Pregnancy Outcomes Amentioning

confidence: 99%

Section: Pregnancy Outcomes Amentioning

confidence: 99%

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Exposure to biologic therapy before and during pregnancy in patients with psoriasis: Systematic review and meta‐analysis

Sánchez‐García,

Hernández‐Quiles,

de‐Miguel‐Balsa

et al. 2023

Acad Dermatol Venereol

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“…Where appropriate, a multidisciplinary team approach, should be undertaken. Until such time that Australian guidance is available, clinicians are referred to recent guidelines and consensus reviews on the management of specific clinical and comorbid conditions in patients with psoriasis including psoriatic arthritis, 59–61 assessing and improving psychological well‐being, 39,62 and women of childbearing age 63,64 …”

Section: Discussionmentioning

confidence: 99%

“…Until such time that Australian guidance is available, clinicians are referred to recent guidelines and consensus reviews on the management of specific clinical and comorbid conditions in patients with psoriasis including psoriatic arthritis, [59][60][61] assessing and improving psychological well-being, 39,62 and women of childbearing age. 63,64 The treatment landscape for moderate to severe psoriasis is rapidly changing. The availability of new targeted treatment options has the potential to reduce the burden of disease in these patients.…”

Section: Toward Reducing Treatment Delaysmentioning

confidence: 99%

Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies – Adult patients

Foley,

Gebauer,

Sullivan

et al. 2023

Aust J Dermatology

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BackgroundOver the last decade, the treatment landscape for moderate–severe psoriasis has rapidly evolved. The Australasian College of Dermatologists sought to review and update previously published treatment goals for moderate–severe psoriasis.MethodsA modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7–9 on a 9‐point scale (1 strongly disagree; 9 strongly agree).ResultsConsensus was achieved on 26/29 statements in round 1 and a further 20 statements in round 2. There was strong agreement to expanding the classification/definition of psoriasis severity by including a choice of metrics, incorporating quality of life measures, and widening the scope of high‐impact sites. Consensus was also reached on revised treatment response criteria, which were then incorporated into a new treatment algorithm. There was discordance with the current requirement to undertake a trial with established systemic agents before accessing targeted therapy.ConclusionThe ability of new targeted treatment options to change the narrative in psoriasis patient care can only be properly realised if challenges to timely and equitable access are addressed. The proposed framework for the assessment, classification and management of moderate–severe psoriasis aligns with international recommendations. Its adoption into Australian clinical practice is hoped to improve treatment outcomes and patients' satisfaction with their care.

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Defining well-being in psoriasis: A Delphi consensus among healthcare professionals and patients

Daudén,

Belinchón,

Colominas-González

et al. 2024

Sci Rep

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Psoriasis is a chronic skin disease that negatively impacts on patient’s life. A holistic approach integrating well-being assessment could improve disease management. Since a consensus definition of well-being in psoriasis is not available, we aim to achieve a multidisciplinary consensus on well-being definition and its components. A literature review and consultation with psoriasis patients facilitated the design of a two-round Delphi questionnaire targeting healthcare professionals and psoriasis patients. A total of 261 panellists (65.1% patients with psoriasis, 34.9% healthcare professionals) agreed on the dimensions and components that should integrate the concept of well-being: emotional dimension (78.9%) [stress (83.9%), mood disturbance (85.1%), body image (83.9%), stigma/shame (75.1%), self-esteem (77.4%) and coping/resilience (81.2%)], physical dimension (82.0%) [sleep quality (81.6%), pain/discomfort (80.8%), itching (83.5%), extracutaneous manifestations (82.8%), lesions in visible areas (84.3%), lesions in functional areas (85.8%), and sex life (78.2%)], social dimension (79.5%) [social relationships (80.8%), leisure/recreational activities (80.3%), support from family/friends (76.6%) and work/academic life (76.5%)], and satisfaction with disease management (78.5%) [treatment (78.2%), information received (75.6%) and medical care provided by the dermatologist (80.1%)]. This well-being definition reflects patients’ needs and concerns. Therefore, addressing them in psoriasis will optimise management, contributing to better outcomes and restoring normalcy to the patient’s life.

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Management of Psoriasis During Preconception, Pregnancy, Postpartum, and Breastfeeding: A Consensus Statement

Cited by 7 publications

References 91 publications

Exposure to biologic therapy before and during pregnancy in patients with psoriasis: Systematic review and meta‐analysis

Exposure to biologic therapy before and during pregnancy in patients with psoriasis: Systematic review and meta‐analysis

Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies – Adult patients

Defining well-being in psoriasis: A Delphi consensus among healthcare professionals and patients

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