Use of biologic drugs for psoriasis safe during pregnancy

The study's findings in the Journal of the European Academy of Dermatology and Venereology suggest that biologic drugs are safe and pose an acceptable risk to neonates/fetuses.

Psoriasis involves chemokine and cytokine dysfunction, significantly increasing tumour necrosis factor (TNF)-alpha. The authors note that this can raise the risk of preterm delivery, intrauterine growth restriction, and even miscarriage.

Biologicals have transformed the management of severe disease phenotypes in psoriasis and are often prescribed in women of childbearing age. However, there is a shortage of information on the safety of biologicals in pregnancy. To fill this knowledge gap, V. Sánchez-García, Institute for Health and Biomedical Research (ISABIAL), Alicante, Alicante, Spain, and colleagues conducted a systematic review and meta-analysis to describe the pregnancy outcomes and characteristics in patients with psoriasis exposed to biologics within three months before or during pregnancy. They also estimated the pooled prevalence of elective, spontaneous, and total abortions and congenital malformations in their newborns.

For this purpose, the researchers performed bibliographic searches in the online databases until 14 April 2022. There were no restrictions on publication date or sample size. Two reviewers evaluated nonrandomized studies and randomized controlled trials reporting pregnancy outcomes in women with biologics exposure indicated for psoriasis during the pre-gestational and gestational period.

Studies on rheumatologic or gastroenterological immune-mediated inflammatory diseases were excluded. Fifty-one observational studies were included, involving 739 pregnancies exposed to approved biologics for psoriasis.

The authors reported the following findings:

• The 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%, and elective abortions were 10.8%.
• Congenital malformations occurred in about 3.0% of live births exposed to biologics during pregnancy.
• No evidence of a risk increase for miscarriage/abortion or congenital malformations linked to biological drug exposure during pregnancy and/or conception was found.

"Biologics exposure during pregnancy or conception for psoriasis does not seem to be linked to an increased risk of congenital malformations or miscarriage/abortion, showing similar rates to the general population," the researchers wrote. "These findings suggest that biologic drugs are safe and pose an acceptable risk to the fetuses/neonates."

Further research is required to determine the actual indication for biologic therapy in pregnant psoriasis patients and fully characterize the association between psoriasis, treatment, and pregnancy outcomes," they concluded.

Reference:

Sánchez-García V, Hernández-Quiles R, de-Miguel-Balsa E, Giménez-Richarte Á, Ramos-Rincón JM, Belinchón-Romero I. Exposure to biologic therapy before and during pregnancy in patients with psoriasis. Systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2023 Jun 1. doi: 10.1111/jdv.19238. Epub ahead of print. PMID: 37262303.