Use of Antipsoriatic Biologics Is Safe During Conception and Pregnancy

Biologic therapy for psoriasis shortly before and during pregnancy appears to be safe and is not associated with an increased risk for miscarriage, abortion, or congenital malformations, according to study results published in the Journal of the European Academy of Dermatology and Venereology.

Investigators aimed to examine the effects of biologics on pregnancy outcomes in women with psoriasis who were exposed to biologics within 3 months before or during pregnancy. The prevalence of spontaneous, elective, and total abortions was estimated, as well as congenital malformations in the women’s newborns.

The investigators conducted a systematic review and meta-analysis using multiple databases, including PubMed, Embase, Scopus, and Web of Science. The study followed PRISMA guidelines and evaluated randomized controlled trials and nonrandomized studies that reported pregnancy outcomes in women exposed to biologics for psoriasis during or before pregnancy. The investigators excluded any research on immune-mediated inflammatory diseases related to rheumatology or gastroenterology. Prevalence estimates were pooled using a random-effects model, regardless of data heterogeneity.

A total of 51 observational studies were included, with 713 patients (739 pregnancies) exposed to biologics approved for the treatment of psoriasis. Patients’ mean age was 30.3 years (SD, 5.6; range, 19-44). The most common comorbidities were past or current smoking (29.5%), psoriatic arthritis (16.0%), psychiatric disorders (13.5%), hypertension (6.8%), and diabetes (4.3%). The predominant psoriasis type was plaque psoriasis (96.7%). Ustekinumab was used in 35.9% of pregnancies, etanercept in 19.3%, infliximab in 12.7%, and ixekizumab in 5.9%. Other agents were used in less than 4% of patients, and no biologic was specified in 16.2% of the pregnancies. Exposure to these agents was limited to the first trimester in 70.4% of pregnancies (mean [SD] duration of exposure, 16.8 [15.2] weeks), and no study reported concomitant use of systemic teratogenic antipsoriatic therapies.

The likelihood of miscarriage was estimated at 15.3% (95% CI, 12.7%-18.0%). The estimated prevalence of elective abortions, on the other hand, was 10.8% (95% CI, 7.7%-14.3%). Additionally, congenital malformations only occurred in approximately 3.0% of live births among infants whose mothers were exposed to antipsoriatic biologics during pregnancy (95% CI, 1.6%-4.8%).

Study limitations include varying definitions of outcomes between studies, lack of long-term follow-ups data on newborns, and a potential overestimation in the incidence of congenital malformations due to publication bias.

The investigators concluded, “[E]xposure to biologics for treating psoriasis during pregnancy and/or conception appears to be unrelated to a higher risk of miscarriages or congenital malformations.” They continued, “These results are consistent regardless of the biologic therapy administered, suggesting the drugs are safe and pose an acceptable risk.”

This article originally appeared on Dermatology Advisor