Use of biologic therapies for psoriasis during pregnancy was not associated with adverse neonatal outcomes, according to study data published in Dermatologic Therapies. Even so, study investigators advised that biologic agents be prescribed with caution during pregnancy, particularly if beyond the first trimester.
Limited data is available on the relationship between biologic therapy use for psoriasis and pregnancy outcomes. Study investigators sought to assess the effects of biologics exposure during pregnancy.
This was a retrospective case series that assessed patients with psoriasis who received biologic therapies during pregnancy from 2006 to 2019. They were recruited from a tertiary referral center in Turkey. Demographic and clinical data were ascertained by medical record review. Study investigators obtained data on the long-term outcomes of exposed children from mothers during follow-up visits or telephone interviews. Outcomes of interest in exposed children included growth and development trajectories, history of infections, history of hospitalizations, allergies, and psoriasis. Pregnancy outcomes were also assessed, including mode of delivery, complications of delivery, neonatal maturity, and adverse outcomes. Study investigators also conducted literature reviews for studies assessing the long-term outcomes of exposed mothers and children.
The case series included data from 9 pregnancies in 6 women who received biologic therapies for psoriasis. Median age of participants was 33.0 years (range, 24-40 years); median disease duration was 8.5 years (range, 3-23 years). At the time of conception, median duration of biologic therapy was 30 months (range, 6 weeks – 50 months). All patients were in clinical remission and discontinued biologic therapy at the time pregnancy was diagnosed. However, 1 patient developed recalcitrant generalized pustular psoriasis of pregnancy and re-initiated biologic therapy. No patients reported any adverse events related to biologic therapy.
In all, 7 pregnancies resulted in delivery of healthy, full-term babies. One pregnancy ended in elective abortion, and 1 was diagnosed as a right tubal ectopic pregnancy and subsequently terminated. Follow-up time after birth ranged from 14 months to 13 years. All children showed normal growth and development. Only 1 infant experienced an infection requiring antibiotherapy within the first year of life. This infant was exposed to ustekinumab during the first trimester. None of the children displayed allergies, malignancies, or psoriasis.
No clear relationship was identified between neonatal exposure to biologic therapy and adverse neonatal or pregnancy outcomes. These results corroborate literature data, which similarly suggests no such relationship between these variables. In 1 retrospective study that assessed outcomes in exposed children, growth, and physiological development were normal.
Limitations to this study included its retrospective design, relatively small sample size of 6 women, and the lack of existing literature on the topic. Further study is necessary to better understand the risks associated with biologic therapy use during pregnancy, the investigators believe.
Study researchers concluded that until a clearer picture is available, biologics should be reserved for high-need patients. They added that “[biologic therapy use in pregnancy] requires a careful assessment of the risk/benefit ratio on a case-by-case basis, as its impact on the long-term development of exposed infants and children is yet to be elucidated.”
Kobaner GB, Ekinci AP. 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. Dermatol Ther. Published online October 17, 2020. doi:10.1111/dth.14420