Stephan Brigitte, Sommer Rachel, Augustin Matthias, Ganjuur Nomun, da Silva Neuza
Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Int J Womens Dermatol. 2024 Nov 15;10(4):e187. doi: 10.1097/JW9.0000000000000187. eCollection 2024 Dec.
For patients with moderate-to-severe psoriasis and current childbearing/pregnancy, the choice of therapy is limited.
The present study compared the disease burden and treatment choices in women of childbearing age (WoCBA) with and without a current wish for pregnancy.
Female patients aged 18 to 45 years, with moderate-to-severe psoriasis vulgaris, were consecutively recruited. The patients reported on sociodemographic/reproductive characteristics and quality of life impairments. The physicians assessed disease severity, comorbidities, and current treatment(s). Both patients' and dermatologists' perceptions of shared decision-making for the current systemic treatment were surveyed.
Participants were 145 WoCBA with psoriasis: 73 were pregnant or reported a desire to conceive (group CB+) and 72 reported no wish to have (more) children (group CB-). Patients without childbearing wishes were older and often had previous children; no significant differences in clinical features or quality of life impairments were found. A significantly higher proportion of patients in the CB+ group were prescribed tumor necrosis factor alpha blockers, particularly certolizumab pegol. This treatment option was associated with previous children and the desire to conceive, but not with disease variables. Family planning was more often discussed and considered in the clinical decision for the CB+ group, but patient-doctor agreement for shared decision-making was fair-to-moderate.
The small sample size prevented comparative analyses between patients planning a pregnancy in the short- vs long-term future. In addition, specific variables related to the decision-making process for the current therapy need to be assessed and examined in more detail in further research.
For WoCBA with childbearing wishes, tumor necrosis factor alpha blockers were most frequently prescribed, in accordance with current guidelines/recommendations. Decision-making for continuing or changing systemic therapy during pregnancy must take into account medication specificities and the vulnerable stages in pregnancy, as well as the limited amount of pregnancy-compatible drugs.
对于中重度银屑病且目前处于育龄期/孕期的患者，治疗选择有限。
本研究比较了有和没有当前妊娠意愿的育龄期女性（WoCBA）的疾病负担和治疗选择。
连续招募年龄在18至45岁、患有中重度寻常型银屑病的女性患者。患者报告社会人口统计学/生殖特征和生活质量损害情况。医生评估疾病严重程度、合并症和当前治疗情况。对患者和皮肤科医生对当前全身治疗的共同决策的看法进行了调查。
参与者为145名患有银屑病的WoCBA：73名怀孕或表示有怀孕意愿（CB+组），72名表示没有（更多）生育意愿（CB-组）。没有生育意愿的患者年龄较大且通常有过孩子；在临床特征或生活质量损害方面未发现显著差异。CB+组中显著更高比例的患者被处方使用肿瘤坏死因子α阻滞剂，尤其是赛妥珠单抗。这种治疗选择与有过孩子和怀孕意愿相关，但与疾病变量无关。在CB+组的临床决策中，计划生育的讨论和考虑更为频繁，但患者与医生对共同决策的达成情况为中等。
样本量较小，无法对近期和远期计划怀孕的患者进行比较分析。此外，与当前治疗决策过程相关的特定变量需要在进一步研究中进行更详细的评估和研究。
对于有生育意愿的WoCBA，根据当前指南/建议，最常处方使用肿瘤坏死因子α阻滞剂。在孕期继续或改变全身治疗的决策必须考虑药物特异性、孕期的脆弱阶段以及与妊娠兼容的药物数量有限等因素。
