Psoriasis and pregnancy outcomes in biological therapies: a real‐life, multi‐centre experience

Abstract

four of them) or by RCM alone (evaluation performed by six of them) 1 year before and results were compared with the previous study. Mean sensitivity, specificity and overall diagnostic accuracy (ACC) and 95% CI were calculated for the specific diagnosis of different facial lesions (Table 1). As expected, considering the evaluation of the seven experts, the combination dermoscopy/RCM had a higher mean ACC for both malignant tumour (including LM/LMM) and LM/LMM of the face (84%, CI 80-89 and 84%, CI 79-89, respectively) than the two imaging techniques alone (74%, CI 68-80 for dermoscopy vs. 80%, CI 75-85 for RCM in case of LM/LMM and 75%, CI 68-80 for dermoscopy vs. 80%, CI 74-85 for RCM in case of malignant tumour). Notably, ACC increased for each investigator. The superiority of the ACC of the combination dermoscopy/RCM on the single imaging techniques for LM/LMM was also observed when comparing the current data to the results obtained in the previous study by all the 21 investigators. Considering all evaluations, the ACC increased from dermoscopy to RCM and to dermoscopy plus RCM. According to the CI, the combination dermoscopy/RCM improved both mean sensitivity and mean specificity of RCM alone for LM/LMM, whereas it highly improved mean sensitivity of dermoscopy alone but not its mean specificity (sensitivity of 65% CI 57-73, 82% CI 76-89 and 85% CI 80-91 and specificity of 88% CI 82-95, 77% CI 68-86 and 83% CI 75-91 for dermoscopy, RCM, and dermoscopy plus RCM, respectively). As already discussed, this fact was probably related to the presence of hyper-reflective dendritic Langerhans cells under RCM mistaken for neoplastic melanocytes in the epidermis of most misdiagnosed benign lesions. 9 Concerning the facial lesions other than LM/LMM, we also observed an increase in ACC with the combination dermoscopy/RCM (Table 1). In conclusion, this study shows that the integration of dermoscopy and RCM increases the ACC of both these techniques used alone for facial tumours. More in-depth studies should be carried out, even using machine learning techniques, for optimal integration of dermoscopic data with RCM data, in order to increase ACC by reducing possible false positives induced by the RCM examination. This study received the approval from the Ethical Committee of the University Hospital of Saint-Etienne (Institutional review board number 672016/CHUSTE).

The unforeseen during biotechnological therapy for moderate‐to‐severe psoriasis: How to manage pregnancy and breastfeeding, infections from Mycobacterium tuberculosis , hepatitis B virus, hepatitis C virus, and HIV , surgery, vaccinations, diagnosis of malignancy, and dose tapering

“…To conclude, biotechnological therapies seem to be safe 10,11,38 and, in selected circumstances, their use should be considered even in the case of previous malignancies 16 …”

Interaction of psoriasis and pregnancy: Maternal and fetal outcomes

“…However, the authors stated that the diverse fi ndings across disease groups in this study may indicate an association related to the underlying disease activity rather than to agent-specifi c effects [71]. As a general approach, it is recommended that women using anti-TNF- avoid pregnancy and be monitored if they have already become pregnant, but there is no conclusive evidence that adalimumab, infl iximab, etanercept and certolizumab pegol treatments are embryotoxic or teratogenic [59][60][61]. Therefore, it has been reported that the continuation of the treatment according to the risk-benefi t balance should be decided individually in each patient.…”

“…In these periods, the most appropriate treatment after topical agents is broadband or especially narrow band that these anomalies may be biased because they actually refl ect negative outcomes collected by the FDA [66,67]. Data on the safety of anti-TNF- treatments during pregnancy are increasing gradually [59][60][61]. Since these treatments are mostly used in infl ammatory bowel diseases and rheumatoid arthritis, most of the data have been obtained from the literature of gastroenterology and rheumatology [68,69].…”

“…The use of biological agents in lactation is considered to be moderately safe [49,51,58]. Due to greater safety data for anti-TNF- agents, it should be considered before the monoclonal antibodies targeting IL-12/IL-23 or IL-17 cytokines in the treatment of pregnant women with psoriasis [57][58][59][60]. Further, large pharmacovigilance studies are needed for the safety of these new agents in pregnancy.…”

Psoriasis and pregnancy in the biologic era, a feared scenario. What do we do now?

“…In fact, it has been observed that when Th17 activity increases above Treg, complications arise, such as preterm labor, preeclampsia, and spontaneous abortions in patients diagnosed with inflammatory diseases such as systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis (Figueiredo & Schumacher, 2016). By extrapolation one can infer that psoriasis in itself is a condition that overshadows pregnancy, as its severity is directly related to complications, according to Yang et al, Johansen et al, Odorici et al, and Bröms et al, it can cause spontaneous abortions, preterm labor, and restricted intrauterine growth (Bröms, Haerskjold, Granath, et al, 2018;Figueiredo & Schumacher, 2016;Johansen, Jimenez-Solem, Haerskjold, Sand, & Thomsen, 2018;Odorici et al, 2019;Yang, Chen, Chen, & Lin, 2011).…”