eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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6/2020
vol. 37
 
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abstract:
Review paper

The use of biological drugs in psoriasis patients prior to pregnancy, during pregnancy and lactation: a review of current clinical guidelines

Witold Owczarek
1
,
Irena Walecka
2
,
Aleksandra Lesiak
3
,
Rafał Czajkowski
4
,
Adam Reich
5
,
Iwona Zerda
6
,
Joanna Narbutt
3

  1. Department of Dermatology, Military Institute of Medicine, Warsaw, Poland
  2. Department of Dermatology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
  3. Department of Dermatology, Paediatric and Oncological Dermatology, Medical University of Lodz, Lodz, Poland
  4. Department of Dermatology and Venerology, Faculty of Medicine, Ludwik Rydygier Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
  5. Department of Dermatology, University of Rzeszow, Rzeszow, Poland
  6. CEESTAHC, Krakow, Poland
Adv Dermatol Allergol 2020; XXXVII (6): 821–830
DOI: https://doi.org/10.5114/ada.2020.102089
Online publish date: 2021/01/06
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Introduction
Information on the possibility of using biological drugs in psoriasis patients planning to conceive, patients who are pregnant or during lactation is limited.

Aim
Presenting recommendations published in clinical guidelines regarding the use of biological drugs – adalimumab, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab, by psoriasis patients in the period of planning pregnancy, during pregnancy or during lactation.

Material and methods
The paper was based on a comprehensive review of over 40 websites of HTA agencies, dermatological associations worldwide and medical databases (PubMed, Embase), the objective of which was to identify clinical guidelines relating to biological treatment of women of childbearing potential, published after 2018, which used GRADE – a system for rating the quality of a body of evidence.

Findings
Certolizumab pegol is recommended in women who are planning to conceive. Furthermore, guidelines indicate other TNF-α inhibitors as possible treatment. Certolizumab pegol is also recommended as first-line treatment in pregnant patients. Furthermore, for trimesters 2 and 3, guidelines allow using other TNF-α inhibitors. Treatment with secukinumab and ustekinumab should be discontinued when planning pregnancy or when pregnancy was diagnosed. Biological treatment during pregnancy and lactation (continuation or initiation of treatment) can be used only after an analysis of risks and benefits has been conducted.

Conclusions
TNF-α inhibitors seem to be the safest and most researched biological drugs used in psoriasis treatment of patients planning to conceive, during pregnancy or lactation. Given its non-existent or minimal placental permeability, most likely the safest alternative is certolizumab pegol.

keywords:

pregnancy, lactation, psoriasis, biological treatment, tumor necrosis factor-α inhibitors
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