Effect of Exposure to Biologic Therapy Before and During Pregnancy in Patients With Psoriasis

Abstract

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 fetuses/neonates.

TAKE-HOME MESSAGE

• This systematic review and meta-analysis assessed pregnancy outcomes in women with psoriasis exposed to biologics within 3 months before or during pregnancy. Most administrations occurred during the first trimester, primarily with ustekinumab, followed by etanercept, infliximab, and ixekizumab. The prevalence of miscarriage was estimated at 15.3%, elective abortions at 10.8%, and congenital malformations at approximately 3.0% of live births exposed to biologics during pregnancy, rates similar to those in the general population.
• Biologic drugs commonly used for patients with psoriasis may have a favorable safety profile during pregnancy, with potentially acceptable risks to fetuses/neonates.

–  Rob Quiring, MD

Journal of the European Academy of Dermatology and Venereology: JEADV

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

J Eur Acad Dermatol Venereol 2023 Jun 01;[EPub Ahead of Print], V Sánchez-García, R Hernández-Quiles, E de-Miguel-Balsa, Á Giménez-Richarte, JM Ramos-Rincón, I Belinchón-Romero 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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