Safety of Psoriatic Biologics in Pregnancy Save

Little is known about the safety of newer biologic use during pregnancy, especially in patients who either conceive while on a biologic or must remain on a biologic during pregnancy (often the case with IBD and inflammatory arthritis). A report from ACR 2021 (Abstract 1713) examined the risk of serious infections (SIE) in the offspring of mothers taking either vedolizumab or ustekinumab for IBD, psoriasis or psoriatic arthritis.  They found no clear excess risk for SIE in the offspring, but did note a trend suggesting caution.

See Dr. Rachel Tate's video review of this abstract and her impressions.

This study examined 16,115 births from 7,612 women with PsO/PsA, or IBD, and found a number of these offspring exposed ustekinumab (n=52), vedolizumab (n=43); both TNFi and vedolizumab (7), TNFi (n=1,585), and 1,857 to non-biologic immunosuppressives; these were compared to offspring who were unexposed (n=12,585).

Offspring SIE rates were

• ustekinumab 3.8% (95% CI 0.4-13.9),
• TNFi  -  2.7% (95% CI 1.9-3.6)
• Vedolizumab - 2.3% (95% CI 0.4-12.0)
• Unexposed - 2.6% (95% CI 2.3-2.8)

A nonsignificant trend for increased risk was seen with ustekinumab (OR 1.6, 0.4-6.8), that was not seen with vedolizumab (OR 0.9, 0.1-6.2) or TNFi (OR 1.0, 0.6-1.4).

Such data may influence biologic choice in and around pregnancy.