Safety of conventional systemic therapies for psoriasis on reproductive potential and outcomes

Abstract

The effects of conventional systemic therapies for psoriasis on pregnancy outcomes, lactation, male fertility and mutagenicity are common concerns in the clinical setting. There is relatively little evidence to guide clinician and patient. In this study, we review the safety profile of the commonly used conventional systemic therapies used for psoriasis in individuals of reproductive potential. Safety data are derived from large-scale registries, adverse-event reporting databases, clinical trials and case reports. We assess the effect of each therapy on adverse pregnancy outcomes, including congenital malformations, and lactation with maternal administration. We also assess the effect of the therapies on male fertility and potential mutagenicity with paternal administration. We provide applicable guidance to inform clinician and patient before and after conception.

• Acitretin
• ciclosporin
• fumaric acid esters
• methotrexate
• pregnancy

Declaration of interest

R. B. W. has acted as a consultant and/or speaker and/or received research grants for Abbvie, Amgen, Celgene, Eli Lilly, Novartis, Medac, Pfizer, Janssen and Leo Pharma; U. M. has been an advisor and/or received speakers honoraria and/or received grants and/or participated in clinical trials of the following companies: Abbott/AbbVie, Almirall-Hermal, Amgen, BASF, Biogen Idec, Celgene, Centocor, Eli Lilly, Forward Pharma, Galderma, Janssen, Leo Pharma, Medac, MSD, Miltenyi Biotech, Novartis, Pfizer, Teva, VBL and Xenoport; and C. E. M. G. has received honoraria and/or research grants from Abbvie, Actelion, Amgen, Celgene, Eli Lilly, GSK-Stiefel, Janssen, MSD, Novartis, Pfizer, Sandoz, Trident and UCB.