3 years ago

受孕和妊娠期使用生物疗法:系统综述

C. Nelson-Piercy, L.S. Exton, C.H. Smith, R.T. Woolf, E. Pottinger, A.D. Burden
生物疗法可以有效治疗银屑病,并且通常在育龄期女性中使用。监管部门表示,由于没有充分的研究评估在受孕或妊娠期使用生物制剂的安全性,因此建议在此期间禁用。但事实上,这实施起来很有挑战,因为临床上治疗银屑病需要持续进行。为评估受孕和/或者妊娠期使用生物疗法的安全性,该研究的作者(来自英国)对有关女性在受孕和/或妊娠期使用生物疗法治疗银屑病的相关研究进行了系统综述。作者确定了四项研究,共涉及 1,300 名在孕前 3 个月或孕期前 3 个月使用 TNFi 生物制剂的女性。这些研究表明具有不同炎症(不仅仅是银屑病)的女性在使用 TNFi 后容易出现药物特定的损害,而且其中三项研究表明先天畸形风险增加,一项研究表明早产风险增加。但是,风险很低且不确定是否因 TNFi 所致。作者得出结论,生物制剂对妊娠结局(特别是女性银屑病患者)的潜在影响尚缺乏充分研究,无法准确量化。有关在其他病例中的生物制剂使用数据十分有限。通常建议有生育能力的女性使用常规避孕,但在备孕的情况下,应视具体情况讨论继续或停止生物治疗的风险及好处。大规模研究是必需的,并且应考虑其他可能影响妊娠的因素,比如疾病活动性、其他疗法及母体人口统计特征。

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/bjd.16206

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