Owczarek Witold, Walecka Irena, Lesiak Aleksandra, Czajkowski Rafał, Reich Adam, Zerda Iwona, Narbutt Joanna
Department of Dermatology, Military Institute of Medicine, Warsaw, Poland.
Department of Dermatology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.
Postepy Dermatol Alergol. 2020 Dec;37(6):821-830. doi: 10.5114/ada.2020.102089. Epub 2021 Jan 6.
Information on the possibility of using biological drugs in psoriasis patients planning to conceive, patients who are pregnant or during lactation is limited.
Presenting recommendations published in clinical guidelines regarding the use of biological drugs - adalimumab, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab, by psoriasis patients in the period of planning pregnancy, during pregnancy or during lactation.
The paper was based on a comprehensive review of over 40 websites of HTA agencies, dermatological associations worldwide and medical databases (PubMed, Embase), the objective of which was to identify clinical guidelines relating to biological treatment of women of childbearing potential, published after 2018, which used GRADE - a system for rating the quality of a body of evidence.
Certolizumab pegol is recommended in women who are planning to conceive. Furthermore, guidelines indicate other TNF-α inhibitors as possible treatment. Certolizumab pegol is also recommended as first-line treatment in pregnant patients. Furthermore, for trimesters 2 and 3, guidelines allow using other TNF-α inhibitors. Treatment with secukinumab and ustekinumab should be discontinued when planning pregnancy or when pregnancy was diagnosed. Biological treatment during pregnancy and lactation (continuation or initiation of treatment) can be used only after an analysis of risks and benefits has been conducted.
TNF-α inhibitors seem to be the safest and most researched biological drugs used in psoriasis treatment of patients planning to conceive, during pregnancy or lactation. Given its non-existent or minimal placental permeability, most likely the safest alternative is certolizumab pegol.
关于计划怀孕、已怀孕或处于哺乳期的银屑病患者使用生物药物的可能性的信息有限。
介绍临床指南中发布的关于计划怀孕期、孕期或哺乳期银屑病患者使用生物药物（阿达木单抗、布罗达单抗、赛妥珠单抗、依那西普、古塞库单抗、英夫利昔单抗、司库奇尤单抗、瑞莎珠单抗、苏金单抗、替拉珠单抗和乌司奴单抗）的建议。
本文基于对40多个卫生技术评估机构网站、全球皮肤病学协会和医学数据库（PubMed、Embase）的全面综述，目的是识别2018年后发布的与育龄期女性生物治疗相关的临床指南，这些指南使用了GRADE（一种证据质量评级系统）。
推荐计划怀孕的女性使用赛妥珠单抗。此外，指南指出其他肿瘤坏死因子-α抑制剂也可作为可能的治疗方法。赛妥珠单抗也被推荐为孕妇的一线治疗药物。此外对于妊娠中期和晚期指南允许使用其他肿瘤坏死因子-α抑制剂。计划怀孕或确诊怀孕时应停止使用司库奇尤单抗和乌司奴单抗进行治疗。只有在对风险和益处进行分析后，才可在孕期和哺乳期进行生物治疗（继续或开始治疗）。
肿瘤坏死因子-α抑制剂似乎是计划怀孕、孕期或哺乳期银屑病患者治疗中最安全且研究最多的生物药物。鉴于其不存在或极低的胎盘通透性，最安全的选择很可能是赛妥珠单抗。
