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The Use and Safety of TNF Inhibitors during Pregnancy in Women with Psoriasis: A Review

1
Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen NV, Denmark
2
Department of Dermato-Venereology, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen NV, Denmark
3
Danish Cancer Society Research Center, 2100 Copenhagen Ø, Denmark
4
Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen NV, Denmark
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2018, 19(5), 1349; https://doi.org/10.3390/ijms19051349
Received: 4 April 2018 / Revised: 27 April 2018 / Accepted: 1 May 2018 / Published: 3 May 2018
(This article belongs to the Special Issue Tumor Necrosis Factor (TNF))
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PDF [249 KB, uploaded 3 May 2018]

Abstract

Psoriasis is a chronic immune-mediated inflammatory disease affecting women of childbearing potential. Biologic agents, notably Tumor Necrosis Factor inhibitors (TNFi), are the only current non-contraindicated systemic treatment option during pregnancy. TNFi comprised of complete immunoglobulin G (IgG) antibodies antibodies (adalimumab, golimumab, and infliximab) actively cross the placenta from the second trimester and are detectable in the child up to one year postpartum. Data on safety of TNFi are conflicting; however a trend towards drug-specific harm has been reported, with increased risk of congenital malformations and preterm birth. TNFi exposure may alter the immune system of the infant towards hypersensitivity and reduced response to intracellular infections. Confounding by indication should be considered, as chronic inflammatory disease itself may pose a risk of adverse pregnancy outcomes. The quality of the current evidence is very low and no studies specifically address TNFi safety in women with psoriasis. Nonetheless, risks associated with TNFi treatment must be balanced against the as-yet uncertain risk of adverse outcomes in infants born to women with severe psoriasis. We searched PubMed using Medical Subject Headings (MeSH) terms and identified relevant studies and guidelines. Herein, we present the current knowledge of the use and safety of TNFi during pregnancy in women with psoriasis. View Full-Text
Keywords: Tumor Necrosis Factor; TNF inhibitors; Tumor Necrosis Factor inhibitors; anti-TNF agents; inflammation; drug safety; psoriasis; pregnancy; neonatal; congenital malformations Tumor Necrosis Factor; TNF inhibitors; Tumor Necrosis Factor inhibitors; anti-TNF agents; inflammation; drug safety; psoriasis; pregnancy; neonatal; congenital malformations
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Johansen, C.B.; Jimenez-Solem, E.; Haerskjold, A.; Sand, F.L.; Thomsen, S.F. The Use and Safety of TNF Inhibitors during Pregnancy in Women with Psoriasis: A Review. Int. J. Mol. Sci. 2018, 19, 1349.

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