Moderate to severe psoriasis is an independent risk factor for a variety of adverse pregnancy outcomes, according to Dr. Jennifer C. Cather.
Yet much remains unknown about the impact of psoriasis and its treatment in pregnancy. For this reason, every psoriasis patient who becomes pregnant while on a biologic agent should be strongly encouraged to enter one of the pregnancy registries, Dr. Cather said at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).
She recommended the Organization of Teratology Information Specialists (OTIS), because the group helps inform concerned patients. OTIS operates pregnancy registries for women taking etanercept (Enbrel) or adalimumab (Humira). In addition, pharmaceutical companies that market biologics maintain pregnancy registries for their agents.
The Food and Drug Administration rates methotrexate and acitretin as pregnancy category X drugs and cyclosporine as a category C drug. The anti–tumor necrosis factor agents are category B – meaning animal studies have shown no fetal risk – as are alefacept (Amevive) and ustekinumab (Stelara).
“That doesn’t mean I think you should give a category B agent to people who are pregnant or are planning pregnancy, because I think that the best drug in pregnancy is probably no drug, or light treatment if you can get away with that,” said Dr. Cather, who is in private practice in Dallas …