Fulfilling Great Expectations: Safety of Biologics in Pregnancy and Lactation

The presentation focuses on the safety of biologic agents during pregnancy and lactation, especially concerning psoriasis, atopic dermatitis, and pemphigus. An extensive handout was provided as a reference for healthcare practitioners managing patients who are pregnant or breastfeeding while on biologics. The speaker, a vice chair of the Delphi consensus for the National Psoriasis Foundation, outlined the principles of how biologics transfer from mother to child. It was noted that biologics exhibit minimal transfer in the first trimester, with significant transfer occurring closer to delivery. A discussion on various biologics revealed that agents like infliximab and adalimumab led to higher levels in umbilical blood, while sertralizumab showed undetectable levels during pregnancy and breastfeeding. Examples of safety outcomes and considerations were provided, particularly concerning live vaccines and their risks to infants. The speaker emphasized the importance of weighing the effectiveness of biologics against the potential risks and recommended careful management, especially with TNF inhibitors in areas with tuberculosis. Notably, dupilumab for atopic dermatitis appears safe based on recent studies, although further data is anticipated. Meanwhile, for rituximab in pemphigus, recommendations include contraception for a year post-treatment due to possible effects on infant B-cell development. Overall, the presentation highlighted the evolving understanding of biologics in pregnancy and lactation, the necessity of ongoing data assessment, and encouraged feedback for future educational topics.