Biologics in pregnant women with psoriasis: Real-life practice of dermatologists

The management of plaque psoriasis during pregnancy is not well understood. The Summaries of Product Characteristics (SmPC) for biologics recommend discontinuation during pregnancy, and most should be stopped up to 24 weeks prior to conception. Only certolizumab pegol may be used in pregnancy if appropriate. In France, official guidelines follow the recommendations of the SmPCs; however, practitioners may not always follow these recommendations.

Here, we summarize a study by Tran et al.¹ published in Annales of Dermatology and Venereology on the real-life practice of dermatologists in the management of pregnant women with psoriasis treated with biologics.

Study design¹

• A retrospective, observational, multicenter study by two dermatologist research groups in France.
• Practitioners were sent a two-part survey for completion between March and June 2021. The first part included 6 questions about their profile and the second part included 12 questions assessing their clinical practice concerning the use of biologics during pregnancy.
• Practitioners were also assessed for their confidence with continuing different biologics during pregnancy, using a 10-point Likert scale.
• The following biologics were studied in the survey:

• • Etanercept
  • Infliximab
  • Adalimumab
  • Certolizumab pegol
  • Ustekinumab
  • Brodalumab
  • Ixekizumab
  • Secukinumab
  • Risankizumab
  • Guselkumab

Key findings¹

• A total of 72 practitioners took part in the study, with a mean age of 43.8 years. The majority were female (71.4%) and hospital-based.
• Less than half of practitioners surveyed discontinued biologics before conception as per the SmPC guidelines, with the majority of practitioners discontinuing biologics when pregnancy was confirmed (Figure 1).
• For practitioners with more than 10 years of experience in treating psoriasis, 81% reported not following the SmPC recommendations (p = 0.023).
• Practitioners were most confident in continuing anti-tumor necrosis factor antibodies during pregnancy, with the highest mean confidence index level with certolizumab (9/10), followed by etanercept (7/10) and adalimumab (7/10).

• • Practitioners were least confident in continuing anti-interleukin 17 and 23 antibodies (mean level of confidence = 3/10).

SmPC, Summaries of Product Characteristics.
^*Adapted from Tran, et al.^1
†The SmPC for biologics recommend discontinuation during pregnancy and should be stopped up to 24 weeks prior to conception.

 

Key learnings

The majority of practitioners do not follow SmPC guidelines for discontinuation of biologics before pregnancy; this was seen in practitioners who had more than 10 years’ experience of treating psoriasis. If biologics are required to continue during pregnancy, certolizumab may be the proposed agent of choice. The study findings may be influenced by selection bias and might not fully represent the practices of all dermatologists prescribing biologics. Further studies are needed to better understand the dermatologists’ use of biologics in pregnant women with psoriasis and the factors influencing their decision.