For women who wish to become pregnant, it is important to find an agent that does not cross the placenta. One such agent is the TNFα blocker certolizumab pegol [2]. The CRIB trial showed that there is only minimal to no placental transfer from mother to infant; only 1 infant from 14 exposed mothers had a minimal certolizumab pegol level of 0.042 µg/ml [3].
TNFα blockers seem to be relatively safe during pregnancy. A cohort study analysing the outcomes after anti-rheumatic drug use before and during pregnancy among 150,000 pregnant women and expecting fathers found no major malformations [4]. However, caution is advised in the administration of live vaccines to infants born to female patients treated with infliximab during pregnancy, since infliximab is known to cross the placenta and has been detected up to 6 months in the serum of infants. A case report of a fatal case of disseminated Bacillus Calmette-Guérin (BCG) infection following a BCG vaccine in an infant with an infliximab-exposed mother has been published [5].
There is conflicting data with regard to ustekinumab treatment during pregnancy. The data on IL-17 inhibitors is limited. “The bottom line is that we do not have any data, so their use during pregnancy is questionable,” Prof. Lebwohl said. The same holds true for IL-23 blockers.
The use of conventional immunosuppressive drugs methotrexate and acitretin during pregnancy has shown to have a clear teratogenic effect [6,7]. Cyclosporine therapy is widely used during pregnancy and might be responsible for a higher rate of prematurity [8]. Patients that are treated with cyclosporine are often transplant patients that have a lot going on, so it needs to be used carefully, according to Prof. Lebwohl.
The largest and longest paediatric study with biologics in psoriasis reported today reported 5-year efficacy data of etanercept in children and adolescents with plaque psoriasis [9]. Etanercept was the first drug to get approved in paediatrics. In this study, the Psoriasis Area and Severity Index (PASI) response with etanercept was maintained over 5 years with very few side effects. There is also good data on long-term safety/efficacy with adalimumab in paediatric psoriasis patients over up to 1 year [10].
High doses of infliximab and certolizumab pegol have been used in the management of juvenile idiopathic arthritis but not in dermatologic indications.
Further, ustekinumab has been approved for adolescents after the phase 3 CADMUS study, where at least two thirds of patients aged 12-17 years treated with ustekinumab achieved cleared skin or minimal psoriasis at week 12 [11].
Current data on the use of secukinumab and brodalumab in children comes only from case reports. However, ixekizumab got approved recently as a result of the positive efficacy demonstrated in the IXORA-PEDS study (see Figure) [12].
IL-23 blockers are injected infrequently, which is convenient for children. There is little data on IL-23 blockers yet, but hopefully more will become available, as Prof. Lebwohl stated. The same holds true for apremilast.
Figure: IXORA-PEDS: PASI and sPGA responses with ixekizumab in paediatric patients with moderate-to-severe psoriasis: ixekizumab shows a rapid onset of action [Adapted from 12]
ETN, etanercept; ITT, intention-to-treat; IXE, ixekizumab; PASI, Psoriasis Area and Severity Index; NRI, non-responder imputation; Q4W, every 4 weeks.
*P<0.001 versus placebo
- Lebwohl M. AAD Virtual Meeting Experience, 12-14 June 2020.
- Pasut G. Biodrugs 2014;28 (Suppl 1): S15-23.
- Mariette X, et al. Ann Rheum Dis 2018;77:228-233.
- Viktil KK, et al. Scand J Rheumatol 2012; 41:196-201.
- Cheent K, et al. Crohns Colitis 2010:4:603-5.
- Powell HR, Ekert H. Med J Aust 1971;2:1076-7.
- De Die-Smulders CE, et al. Teratology 1995;52:215-9.
- Bar Oz B, et al. Transplantation 2001:71:1051-5.
- Paller AS, et al. J Am Acad Dermatol. 2016 Feb;74(2):280-287.
- Thaçi D, et al. EADV 2015. FC0206.
- Landells I, et al. J Am Acad Dermatol 2015;73:594-603.
- Paller AS, et al. Br J Dermatol 2020 Apr. 21 [online ahead of print].
Posted on
Previous Article
« Biologic psoriasis treatment to lower cardiovascular risk? Next Article
Cannabinoids: a future role in dermatology? »
« Biologic psoriasis treatment to lower cardiovascular risk? Next Article
Cannabinoids: a future role in dermatology? »
Table of Contents: AAD 2020
Featured articles
Late-Breaking Abstracts
IL-17A and IL-17F blockade remarkably effective in psoriasis
Good response and pruritus reduction in AD with novel selective JAK1 inhibitor
Novel IL-23 blocker risankizumab highly effective and tolerable in psoriasis
Tape stripping – a painless way to distinguish AD and psoriasis?
IL-4/IL-13 blocker dupilumab effective in children with severe AD
Pembrolizumab leads to higher toxicity risk in obese melanoma patients
Can gene expression help to pick the right biologic to treat psoriasis in cancer patients?
Omalizumab for cancer-induced dermatoses
Psoriasis – What Is Hot?
Psoriasis therapy for children and pregnancies
Biologic psoriasis treatment to lower cardiovascular risk?
Systemic Therapies for Dermatologists
How to manage cutaneous side effects of immunotherapy
Cannabinoids: a future role in dermatology?
Hidradenitis Suppurativa/Acne Inversa
Biologics in HS – a growing armamentarium
Pearls of the Posters
Selective IL-23 blocker safe in elderly psoriasis patients
Spironolactone safe for androgenetic alopecia in cancer survivors
Baricitinib beneficial in head and neck AD
ECLIPSE trial: skin clearance independent of PsA status at baseline
Related Articles
August 6, 2020
IL-13 blocker tralokinumab effective in AD
August 6, 2020
Cannabinoids: a future role in dermatology?
© 2024 Medicom Medical Publishers. All rights reserved. Terms and Conditions | Privacy Policy
HEAD OFFICE
Laarderhoogtweg 25
1101 EB Amsterdam
The Netherlands
T: +31 85 4012 560
E: publishers@medicom-publishers.com