Jensen Yeung1,2,3,4, Melinda J Gooderham2,5,6, Parbeer Grewal2,7,8, Chih-Ho Hong2,9,10, Perla Lansang1,3,4, Kim A Papp2,11, Yves Poulin12, Irina Turchin2,13,14, Ronald Vender15,16. 1. Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 2. 468790 2129 Probity Medical Research, Waterloo, ON, Canada. 3. Division of Dermatology, Women's College Hospital, Toronto, ON, Canada. 4. 7938 Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada. 5. SKiN Centre for Dermatology, Peterborough, ON, Canada. 6. Queen's University, Kingston, ON, Canada. 7. 3158 Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 8. Stratica Medical Centre for Dermatology, Edmonton, AB, Canada. 9. Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada. 10. Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada. 11. K Papp Clinical Research, Waterloo, ON, Canada. 12. Centre de Recherche Dermatologique du Québec Métropolitain, Quebec City, QC, Canada. 13. Brunswick Dermatology Centre, Fredericton, NB, Canada. 14. Department of Medicine, Dalhousie University, Halifax, NS, Canada. 15. Department of Medicine, McMaster University, Hamilton, ON, Canada. 16. Dermatrials Research, Dermatology Centre, Hamilton, ON, Canada.
Abstract
BACKGROUND: Plaque psoriasis (PsO) is a chronic inflammatory disease that often presents at peak reproductive age in women of child-bearing potential (WOCBP). With the emergence of biologic therapies to treat PsO, guidance on disease management in WOCBP is needed to inform treatment decisions before, during, and after pregnancy. OBJECTIVES: To develop a practical, up-to-date consensus document, based on available evidence and expert opinion where evidence was lacking, in order to guide both Canadian and international clinicians treating PsO in WOCBP. METHODS: A panel of 9 Canadian dermatologists with extensive clinical experience managing PsO reviewed the relevant literature from the past 25 years in 3 key domains: overview of PsO in WOCBP and clinical considerations, treatment considerations, and postpartum considerations. The structured literature search focused on WOCBP treated with TNF-alpha inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), IL-12/23 inhibitors (ustekinumab), and IL-17 inhibitors (brodalumab, ixekizumab, secukinumab). This literature review, along with clinical expertise and opinion, was used to develop concise and clinically relevant consensus statements to guide practical management of PsO in WOCBP. Experts voted on the statements using a modified Delphi process and prespecified agreement cut-off of 75%. RESULTS AND IMPLICATIONS: After review, discussion, and voting on 19 draft consensus statements at an in-person meeting and remotely, 12 consensus statements were approved by the expert panel. The statements presented here will guide healthcare providers in practical disease management using biologic therapies for the treatment of PsO in WOCBP.
BACKGROUND: Plaque psoriasis (PsO) is a chronic inflammatory disease that often presents at peak reproductive age in women of child-bearing potential (WOCBP). With the emergence of biologic therapies to treat PsO, guidance on disease management in WOCBP is needed to inform treatment decisions before, during, and after pregnancy. OBJECTIVES: To develop a practical, up-to-date consensus document, based on available evidence and expert opinion where evidence was lacking, in order to guide both Canadian and international clinicians treating PsO in WOCBP. METHODS: A panel of 9 Canadian dermatologists with extensive clinical experience managing PsO reviewed the relevant literature from the past 25 years in 3 key domains: overview of PsO in WOCBP and clinical considerations, treatment considerations, and postpartum considerations. The structured literature search focused on WOCBP treated with TNF-alpha inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), IL-12/23 inhibitors (ustekinumab), and IL-17 inhibitors (brodalumab, ixekizumab, secukinumab). This literature review, along with clinical expertise and opinion, was used to develop concise and clinically relevant consensus statements to guide practical management of PsO in WOCBP. Experts voted on the statements using a modified Delphi process and prespecified agreement cut-off of 75%. RESULTS AND IMPLICATIONS: After review, discussion, and voting on 19 draft consensus statements at an in-person meeting and remotely, 12 consensus statements were approved by the expert panel. The statements presented here will guide healthcare providers in practical disease management using biologic therapies for the treatment of PsO in WOCBP.