Biologic exposure in pregnancy with psoriasis was not linked to more adverse outcomes

Design

Retrospective cohort study

Population

1,226 biologic-exposed pregnancies in women with psoriasis versus 1,238 unexposed psoriasis controls

Primary outcome

Overall and individual adverse pregnancy outcomes

Effect

Any adverse outcome 24.1% vs 30.0%; OR 0.76 (95% CI 0.64 to 0.89)

This retrospective cohort compared 1,226 women with psoriasis who were exposed to biologics in pregnancy with 1,238 psoriasis controls who were not. It was published in June, so it is not new.

Any adverse pregnancy outcome occurred in 24.1% of exposed and 30.0% of unexposed women (OR 0.76, 95% CI 0.64 to 0.89). Spontaneous abortion was 8.4% against 10.9% (OR 0.75, 95% CI 0.57 to 0.98), and gestational diabetes 4.2% against 7.4% (OR 0.54, 95% CI 0.38 to 0.77).

The lower rates are more likely to reflect better-controlled disease or confounding than a protective effect of biologics. The reassuring part is the absence of excess harm. Power was limited for non-TNF biologic classes, and trimester-specific exposure was incompletely described.

• Discuss pregnancy plans before starting or switching a biologic in women of reproductive age.
• Counsel that this cohort found no excess of adverse outcomes with biologic exposure.
• Note that evidence for non-TNF biologics is thinner than for TNF inhibitors.
• Do not stop effective treatment abruptly on learning of a pregnancy without a joint decision.

Why it matters

Fear of harm from biologics in pregnancy often drives stopping treatment, and flares carry their own costs.

Don't overread it

A retrospective cohort cannot show that biologics are safe for every drug class or exposure window, and it does not change prescribing labels.

The statistics, in plain English

The odds ratios below 1.0 mean fewer events in the exposed group, which is unlikely to be a benefit of the drugs themselves; women who stay on biologics may simply have milder or better-controlled disease. Retrospective cohorts cannot sort this out.

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