Department for Rheumatology and Hiller Research Institute, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Department of Rheumatology, Sorlandet Hospital, Kristiansand, Norway.
Expert Rev Clin Pharmacol. 2021 Aug;14(8):979-989. doi: 10.1080/17512433.2021.1925536. Epub 2021 May 13.
Psoriatic arthritis (PsA) is the musculoskeletal manifestation of psoriatic disease, an inflammatory systemic disease with a high incidence in the reproductive years. Biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) as well as 'small molecules', are increasingly used to treat subtypes of PsA. Safety concerns exist in the field of fertility for PsA patients since the literature shows discordant results toward the influence of anti-psoriatic drugs.: This comprehensive review critically reviews the available data on the safety of biologics and small molecules in PsA including pregnancy and lactation and men who want to father a child. TNF inhibitors (TNFi) are best studied in relation to reproduction. For other biologics and small molecules, no prospective, controlled studies are available.: No contraindications appear for TNFi in pregnancy, lactation, and paternal exposure. For biologics other than TNFi and small molecules, prospective controlled studies on outcomes after exposure in early and late pregnancy are urgently needed. Potential effects of all biologics on immune function, infection rates, and vaccine responses in prenatally exposed children need to be expanded. Until more data become available, small molecules should be avoided during pregnancy and breastfeeding. More reproduction-related data are expected from various national and international registries in the future.
银屑病关节炎（PsA）是银屑病的一种骨骼肌肉表现，是一种炎症性全身性疾病，在生育期的发病率较高。生物制剂和靶向合成的疾病修饰抗风湿药物（DMARDs）以及“小分子”药物越来越多地用于治疗不同类型的 PsA。由于文献显示抗银屑病药物对生育力的影响存在不一致的结果，因此银屑病关节炎患者在生育领域存在安全性问题。本文全面回顾了生物制剂和小分子药物在银屑病关节炎中的安全性数据，包括妊娠和哺乳期以及希望生育的男性。TNF 抑制剂（TNFi）在生殖方面的研究最多。对于其他生物制剂和小分子药物，尚无前瞻性、对照研究。对于 TNFi，在妊娠、哺乳期和父亲暴露的情况下，似乎没有禁忌证。对于除 TNFi 以外的生物制剂和小分子药物，迫切需要进行早期和晚期妊娠暴露后的结局的前瞻性对照研究。需要扩大所有生物制剂对免疫功能、感染率和产前暴露儿童疫苗反应的潜在影响。在更多数据可用之前，应避免在怀孕期间和哺乳期使用小分子药物。未来，预计会有来自各种国家和国际登记处的更多与生育相关的数据。
