Title:Safety of Anti-TNF Alpha Agents in the Pregnant Psoriatic Patient
Volume: 8
Issue: 1
Author(s): Laurie K. Shallcross and Marcia S. Driscoll
Affiliation:
Keywords:
Biologics, fetal malformation, pregnancy, psoriasis, tumor necrosis alpha, tumor necrosis alpha blockers,
vaccination.
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.
