Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

Abstract

Published experiences of TNF-α inhibition during pregnancy consist of a limited number of case reports, series and ongoing registry data in patients with arthritis and inflammatory bowel disease. A 28-year-old woman – with psoriasis vulgaris since she was 8 years of age and generalized pustular psoriasis during her first pregnancy (partially controlled with ciclosporin, oral prednisone and topical corticosteroids, when lupus anticoagulant was detected at another hospital) – presented 4 months after delivery with severe psoriasis (PASI = 15.4) that did not respond to ciclosporin (3 mg/kg/day). Ten days after the first infusion of infliximab (5 mg/kg), when the patient became aware that she was pregnant again, there was PASI75 response, and the patient wished to continue this treatment after being fully informed. Complete blanching was achieved by week 6 of treatment, and was maintained thereafter until the moment of writing (19 months after the start of treatment). She gave birth by caesarean delivery to a healthy female baby, who was breastfed for 1 month and has developed normally. The current report extends the available evidence on successful infliximab treatment in pregnant women, with the first case of a patient with psoriasis who presented impetigo herpetiformis during her previous pregnancy. No detectable adverse effects were detected in the neonate, despite potential exposure to infliximab throughout gestation and breastfeeding. Even though absolute safety is difficult to prove, available data suggest that women who become pregnant while taking infliximab or other anti-TNFα agents can be reassured regarding the continuation of pregnancy.

Is safety infliximab during pregnancy in patients with inflammatory bowel disease?

“…Burt et al (16) reported a successful pregnancy that had resulted from intercourse 3 days prior to IFX infusion. Also, in a pregnant patient with psoriasis has been used (17). The findings observed in some studies of a possible increase in the number of abortions, premature births or newborns with low birth weight would seem to be more attributable to the disease itself than to the use of these treatments.…”

Impetigo Herpetiformis with Gestational Hypertension: A Case Report and Literature Review

“…Sheth et al [12] presented a case of IH who responded to infliximab treatment. Although its absolute safety is difficult to prove, Puig et al [13] reviewed pregnancy outcomes of 219 cases who had been exposed to tumor necrosis factor antagonists and concluded that women who conceived while taking infliximab or other anti-tumor-necrosis-factor-α agents can be reassured regarding the continuation of pregnancy. Other studies have reported the successful treatment of persistent IH lesions using methotrexate or retinoid photochemotherapy [14,15].…”

Safety of Common Medications for Treating Dermatology Disorders in Pregnant Women

“…These are indicated for treatment of moderate-to-severe plaque type psoriasis that is refractory to phototherapy and systemic treatments, or when other treatments are contraindicated; 40-60% of the patients with chronic psoriasis improve during pregnancy, but 10-20% experience worsening of the disease during pregnancy [34]. Most of the studies covered in our literature search were based on women with rheumatologic or gastrointestinal diseases, who were treated with immune modifiers during pregnancy.…”

“…When there are contraindications, side effects, or refractory disease, the physician should consider immune modifiers [34]. Current data suggest that the risk of congenital anomalies is relatively low, and the benefits may outweigh the risks for patients with severe disease refractory to other treatments [36•].…”

“…If infliximab is administered to a pregnant patient, it should be given during the first 30 weeks of pregnancy and resumed after delivery. Vaccinations with live viruses should be postponed in these infants until they are at least 6 months old [34,39].…”