Biologics in pregnancy with psoriasis: no excess of adverse outcomes

The edition in brief

A retrospective cohort, published in June, compared 1,226 pregnancies in women with psoriasis exposed to biologics against 1,238 unexposed psoriasis controls. Any adverse pregnancy outcome occurred in 24.1% versus 30.0% (OR 0.76), with lower rates of miscarriage and gestational diabetes; the lower rates likely reflect better-controlled disease and confounding rather than protection, but the data are reassuring against harm. Most of the exposure was to TNF inhibitors. A single-centre laboratory study of 100 consecutive sera found an ELISA against the LABD97 fragment of BP180 was positive in 87% of bullous pemphigoid cases, against 66% for the standard NC16A ELISA, and in 83% of cases negative on both commercial tests. A UK open-label feasibility study of upadacitinib in 20 adults with palmoplantar pustulosis reduced PP-PASI from 20.3 to 4.6 at eight weeks, against historic placebo data, which supports a randomised trial rather than routine use. In a phase 2 vitiligo study, ruxolitinib cream reduced CXCL10 in serum and skin, and the fall tracked with repigmentation. The pearl covers drug-induced pemphigoid with DPP-4 inhibitors.