Pregnancy during Ustekinumab Treatment for Severe Psoriasis

Rocha, K.; Piccinin, Mariana Carolina; Kalache, Luciana F; Reichert-Faria, Adriane; Castro, Caio César Silva de

doi:10.1159/000380880

Cited by 46 publications

(25 citation statements)

References 10 publications

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“…Due to a shorter half‐life and less placental transfer, etanercept may be safer if biological therapy is required during pregnancy. Five reports of pregnancy during ustekinumab treatment have been reported, with one resulting in miscarriage . No data exist regarding ustekinumab in breast milk; therefore, ustekinumab should be avoided during breastfeeding.…”

Section: Resultsmentioning

confidence: 99%

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Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

Gisondi

Altomare

Ayala

et al. 2017

Acad Dermatol Venereol

158

159

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Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.

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Section: Resultsmentioning

confidence: 99%

“…Five reports of pregnancy during ustekinumab treatment have been reported, with one resulting in miscarriage. 84 No data exist regarding ustekinumab in breast milk; therefore, ustekinumab should be avoided during breastfeeding.…”

Section: Pregnancy or Patients Wishing Pregnancy In The Near Futurementioning

confidence: 99%

Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

Gisondi

Altomare

Ayala

et al. 2017

Acad Dermatol Venereol

158

159

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“…As discussed in statement 14, cyclosporine may also be considered in corticosteroid-refractory patients with UC. Vedolizumab and ustekinumab may also be options, but there are few cases reporting exposure to these agents during pregnancy [146][147][148][149][150][151] ; in regard to anti-TNF therapies, onset of action may be a concern (see Future Directions).…”

Section: Medical Management Of Ibd During Pregnancymentioning

confidence: 99%

The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy

et al. 2016

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“…The data on anti‐IL‐12/23 monoclonal antibodies are too immature to make any recommendation . The current precautionary approach would be to avoid ustekinumab during pregnancy.…”

Section: Ustekinumab (Adec Category B1)mentioning

confidence: 99%

Psoriasis in those planning a family, pregnant or breast‐feeding. The Australasian Psoriasis Collaboration

et al. 2017

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The Australasian Psoriasis Collaboration has reviewed the evidence for managing moderate to severe psoriasis in those who are pregnant or are breast-feeding, or planning a family. The severity of the psoriasis, associated comorbidities and specific anti-psoriasis treatment, along with other exposures, can have a deleterious effect on pregnancy outcomes. Psoriasis itself increases the risk of preterm and low birthweight babies, along with spontaneous and induced abortions, but no specific birth defects have been otherwise demonstrated. The baseline risk for a live born baby to have a major birth defect is 3%, and significant neuro-developmental problem is 5%. In Australia, pregnant women with psoriasis are more likely to be overweight or obese, depressed, or smoke in their first trimester, and are also less likely to take prenatal vitamins or supplements. Preconception counselling to improve maternal, pregnancy and baby health is therefore strongly encouraged. The topical and systemic therapies commonly used in psoriasis are each discussed separately, with regards to pregnancy exposure, breast-feeding and effects on male fertility and mutagenicity. The systemic therapies included are acitretin, adalimumab, apremilast, certolizumab, ciclosporin, etanercept, infliximab, ixekizumab, methotrexate, NBUVB, prednisone, PUVA, secukinumab and ustekinumab. The topical therapies include dithranol (anthralin), calcipotriol, coal tar, corticosteroids (weak, potent and super-potent), moisturisers, salicylic acid, tacrolimus, and tazarotene. As a general recommendation, effective drugs that have been widely used for years are preferable to newer alternatives with less foetal safety data. It is equally important to evaluate the risks of not treating, as severe untreated disease may negatively impact both mother and the foetus.

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Pregnancy during Ustekinumab Treatment for Severe Psoriasis

Cited by 46 publications

References 10 publications

Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy

Psoriasis in those planning a family, pregnant or breast‐feeding. The Australasian Psoriasis Collaboration

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