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Exposure to biologic therapy before and during pregnancy in patients with psoriasis: Systematic review and meta-analysis.
- Source :
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Journal of the European Academy of Dermatology and Venereology : JEADV [J Eur Acad Dermatol Venereol] 2023 Oct; Vol. 37 (10), pp. 1971-1990. Date of Electronic Publication: 2023 Jun 13. - Publication Year :
- 2023
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Abstract
- Biologicals have transformed the management of severe disease phenotypes in psoriasis and are often prescribed in women of childbearing age. However, information on safety of biologicals in pregnancy are lacking. We conducted a systematic review and meta-analysis aimed to describe the characteristics and pregnancy outcomes in women with psoriasis exposed to biologics within 3 months before or during pregnancy, and to estimate the pooled prevalence of spontaneous, elective and total abortions, and congenital malformations in their newborns. Bibliographic searches were performed in the PubMed, Embase, Scopus and Web of Science databases up to 14 April 2022. No restrictions on sample size or publication date were applied. Review performance complied with PRISMA guidelines, and two reviewers assessed randomized controlled trials and nonrandomized studies reporting pregnancy outcomes in women exposed to biologics indicated for psoriasis during the pre-gestational and/or gestational period. Studies focusing on rheumatologic or gastroenterological immune-mediated inflammatory diseases were excluded. Regardless of data heterogeneity, a random-effects model was used to pool prevalence estimates. We included 51 observational studies, involving 739 pregnancies exposed to approved biologics for psoriasis. Administration was mostly (70.4%) limited to the first trimester, and the most common drug was ustekinumab (36.0%). The estimated prevalence of miscarriage was 15.3% (95% confidence interval [CI] 12.7-18.0) and elective abortions, 10.8% (95% CI 7.7-14.3). Congenital malformations occurred in about 3.0% (95% CI 1.6-4.8) of live births exposed to biologics during pregnancy. Altogether, exposure to biologics for psoriasis during pregnancy and/or conception does not seem to be associated with an increased risk of miscarriage/abortion or congenital malformations, showing similar rates to the general population. These results suggest that biologic drugs are safe and pose an acceptable risk to the foetuses/neonates.<br /> (© 2023 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)
- Subjects :
- Infant, Newborn
Pregnancy
Humans
Female
Ustekinumab therapeutic use
Pregnancy Outcome
Biological Therapy
Abortion, Spontaneous chemically induced
Abortion, Spontaneous epidemiology
Abortion, Spontaneous drug therapy
Psoriasis drug therapy
Psoriasis chemically induced
Biological Products adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1468-3083
- Volume :
- 37
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of the European Academy of Dermatology and Venereology : JEADV
- Publication Type :
- Academic Journal
- Accession number :
- 37262303
- Full Text :
- https://doi.org/10.1111/jdv.19238