Biologics and Pregnancy: A Q&A With Ben Lockshin, MD

Ben Lockshin, MD, FAAD, assistant professor at Georgetown University’s Department of Dermatology, and director of the clinical trials center at US Dermatology Partners in Washington, DC, took a deep dive into the complexities and advancements in biologic treatments for pregnant patients during his session “Dermatology and Pregnancy” at the 2024 Fall Clinical Dermatology Conference for PAs and NPs. Addressing the prevalent uncertainty among healthcare providers regarding the management of patients who are pregnant or considering pregnancy, Lockshin emphasized the importance of empowering dermatology clinicians with data-driven knowledge and resources to best treat this patient population. In an interview with Dermatology Times, he explained his approach to continuing biologic therapies into pregnancy with informed timing adjustments.¹

Dermatology Times: What sparked your interest in exploring advancements in biologic treatments for pregnant patients?

Lockshin: I think most of us don't feel that we're good at treating patients that are either thinking about becoming pregnant or that are pregnant. I think this presentation allows people to have some data to empower themselves when managing patients on biologic therapies.

Dermatology Times: What data is available for clinicians to weigh the risks and benefits of prescribing biologics to pregnant patients?

Lockshin: So as I mentioned in my talk, there's very little limited clinical trial data out there in this patient population. In fact, most phase 3 studies exclude pregnant and breastfeeding patients. And because of this, all the data that we primarily derive is from post-marketing surveillance, and the OTIS registry² has been an excellent resource for patients and providers to really gain insight in terms of the risks that these patients are exposed to, with whatever medication they're on. But that being said, biologic therapies, there's very limited transplacental term transmission in the first trimester, which gives you comfort to continue prescribing until someone gets pregnant. Many providers revert to the most cautious way of prescribing which is to hold medication, which can be detrimental to patients that have atopic dermatitis and psoriasis. Hopefully, after hearing this talk, many of the providers will learn that it is okay for patients to get pregnant on these biologic therapies and to consider stopping sometime during the second or third trimester.

Dermatology Times: What do you believe the future holds in serving pregnant patients with inflammatory skin conditions?

Lockshin: We've come a really long way in terms of managing inflammatory disease, and then I think we are far from the goal line. Maybe we're at the 20 yard line when it comes to psoriasis, and maybe at the 50 yard line when it comes to atopic dermatitis, and for hidradenitis suppurativa, I think we've got a lot of ground to make up in terms of getting patients to live a life that they should expect to live free of disease without the burden of thinking that this will come back or that they'll experience a flare. So hopefully in the next few years with the various drugs in the pipeline, we'll be able to achieve the same results in atopic dermatitis vitiligo, alopecia areata, as we've seen with psoriasis, Hopefully in the next 20 years, we'll be in a place where we can find treatments that will actually cure this disease rather than manage it. We are really practicing medicine in the golden era of pharmacology and drug development, and I think it'sreally important for us as clinicians to continue to understand, adapt, and develop and utilize the new therapies that are out there to better treat our patients. If we do this, we'll be able to not only treat our patients with more precision, we'll be able to find treatments that are more precise for their individual disease state, limiting adverse events while increasing levels of efficacy.

Transcript has been edited for clarity.

References

1. Lockshin B. Dermatology and pregnancy. Presented at: 2024 Fall Clinical Dermatology Conference for PAs and NPs; May 31-June 2, 2024; Scottsdale, AZ.
2. Scialli AR. The Organization of Teratology Information Services (OTIS) registry study. J Allergy Clin Immunol. 1999;103(2 Pt 2):S373-S376. doi:10.1016/s0091-6749(99)70267-8