Safety of Anti-TNF Alpha Agents in the Pregnant Psoriatic Patient

Laurie   K.   Shallcross; Marcia   S.   Driscoll

Abstract

Psoriasis is a chronic, often difficult to control condition which accounts for significant morbidity worldwide. The United States Food and Drug Administration (FDA) approved multiple TNF alpha blockers in the 21st century for the treatment of psoriasis. These agents provide an alternative treatment approach for those with moderate to severe psoriasis, who fail to respond adequately to traditional therapies. The increasing use of these agents in women of childbearing age raises questions concerning their safety in the pregnant psoriatic patient. A review of case reports and registry data was performed on the outcomes of pregnancies in psoriatic patients and in those with other inflammatory conditions who were exposed to these biologic agents. To date, it remains inadvisable to continue pregnant patients on these medications if alternative, well-established therapies are effective. However, for those women unable to tolerate alternative treatments or who are inadvertently exposed to TNF-alpha inhibitors during pregnancy, the published data do not indicate an increased risk of fetal malformation or a need to recommend pregnancy termination. Transplacental transfer of these drugs is greatest during the last two trimesters of pregnancy, which may result in persistent detectable drug levels in the newborn infant. If a fetus is exposed to TNF alpha blockers toward the end of pregnancy, then live vaccinations in these infants should be delayed until drug levels in infant serum are undetectable, or for at least 6-7 months if levels cannot be measured.

Keywords: Biologics, fetal malformation, pregnancy, psoriasis, tumor necrosis alpha, tumor necrosis alpha blockers, vaccination.

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