I. Hamann1, D. Xie2
The treatment of severe psoriasis has been greatly enhanced by the emergence of biologic agents. Each year new agents are becoming available offering inhibition of different cytokine targets, improved efficacy and a wide range of choice. Unfortunately, there are limited data available on the safety of biologics in pregnancy and lacta- tion. Guidelines discuss potential toxicities but do not offer a clear pathway for treatment.
We will present a brief case study involving two recent pregnancies, their management and outcomes. The data available for all currently available systemic treatments for psoriasis in pregnancy will be presented.
We will also present the data on efficacy and safety for the TNF inhibitor, certolizumab, which has recently been approved by the TGA for chronic plaque psoriasis and has been used in rheumatology in Australia for a number of years.
We hope to stimulate discussion for development of new guidelines for treating severe psoriasis in pregnancy and lactation.
References
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2016. Psoriasis and adverse pregnancy outcomes: a systematic review of observational studies. British Journal of Dermatology,
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2. Clarke, D, Hilbish, K, Waters, D, Newcomb, D & Chellman, G
2015. Assessment of ixekizumab, an interleukin-17A monoclonal antibody, for potential effects on reproduction and development, including immune system function, in cynomolgus monkeys. Reproductive Toxicology, 58, 160–173.
3. Rademaker, M, Agnew, K, Andrews, M, Armour, K, Baker, C, Foley, P, Frew, J, Gebauer, K, Gupta, M, Kennedy, D, Marshman, G & Sullivan, J 2018. Psoriasis in those planning a family, preg- nant or breast-feeding. The Australasian Psoriasis Collaboration. Australasian Journal of Dermatology, 59, 86–100.
4. Tsao, NW, Sayre, EC, Hanley, G, Sadatsafavi, M, Lynd, LD, Marra, CA & De Vera, MA 2018. Risk of preterm delivery and small-for-gestational-age births in women with autoimmune dis- ease using biologics before or during pregnancy: a population- based cohort study. Annals of the Rheumatic Diseases, annrheumdis-201.
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1016/j.ijwd.2016.12.003. eCollection 2017 Mar. Update on biologic safety for patients with psoriasis during pregnancy. Porter ML1, Lockwood SJ1, Kimball AB2,3. Author information 1 Clinical Unit for Research Trials and Outcomes in Skin (CURTIS), Mas- sachusetts General Hospital, Boston, MA. 2 Department of Derma- tology, Harvard Medical School, MA. 3 Harvard Medical Faculty Physicians, Beth Israel Deaconess Medical Center, Boston, MA
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