Case and Research Letter
A Case Series of Patients With Psoriasis Exposed to Biologic Therapy During Pregnancy: The BIOBADADERM Register and a Review of the Literature
Serie de casos de pacientes psoriásicas expuestas a terapia biológica durante el embarazo. Registro BIOBADADERM y revisión de la literatura
B. Echeverría-Garcíaa, A. Nuño-Gonzálezb, E. Daudenc, F. Vanaclochad, R. Torradoe, I. Belinchónf, B. Pérez-Zafrillag,h,
, Grupo de estudio BIOBADADERM ◊
Autor para correspondencia
a Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain
b Servicio de Dermatología, Hospital Universitario Rey Juan Carlos, Madrid, Spain
c Servicio de Dermatología IIS-IP, Hospital Universitario La Princesa, Madrid, Spain
d Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
e Servicio de Dermatología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
f Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
g Unidad de Investigación, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain
h Unidad de Investigación, Gerencia de Atención Integrada de Albacete, Albacete, Spain
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Registro BIOBADADERM y revisión de la literatura" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Biologic therapy has been a step forward in the control of moderate and severe psoriasis. However, major issues remain, including a better understanding of the risks associated with the use of this therapy during pregnancy. This information is usually obtained from the description of cases of accidental exposure in clinical trials, in observational studies, in clinical practice, or in patient registers such as BIOBADADERM, the methodology of which has been described previously. Based on a review of cases in BIOBADADERM and in the literature, our aim has been to define the risk of exposure to biologic agents during pregnancy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In addition to the data in BIOBADADERM, specific information was gathered on the presence or absence of fetal abnormalities. The estimated duration of fetal exposure was calculated using the date of the final dose administered and the date of the last menstrual period.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The search for studies to review was performed on the Medline (via OVID) and Embase databases up to March 2016, with no language limits, combining 3 groups of terms: (psoriasis) AND (pregnancy) AND (infliximab, etanercept, adalimumab, ustekinumab, tumor necrosis factor-alpha/adverse effects, tumor necrosis factor-alpha/antagonists and inhibitors, tumor necrosis factor-alpha/contraindications, tumor necrosis factor-alpha/drug effects and interleukin-12,23 p40 subunit/antagonists and inhibitors). All terms were used as MeSH and as free terms</p><p id="par0020" class="elsevierStylePara elsevierViewall">We present 7 cases of patients with moderate or severe psoriasis directly exposed to biologic therapy either during gestation or at conception as accidental exposure to the drug (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>). Two of the patients had 2 pregnancies with healthy children.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In patients 1A, 1B, and 2, the biologic was administered during the first weeks of pregnancy and was discontinued when the situation became known. Deterioration of the patient's psoriasis during the second or third trimester of pregnancy subsequently made it necessary to administer treatment with traditional systemic drugs.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Complications or adverse events were recorded during the pregnancy in 3 of the 7 patients: deterioration of the psoriasis (case 1A); systemic hypertension at the first obstetric appointment (case 4); and sciatic pain, erythema nodosum, nausea, fatigue, dizziness, and vaginal infection (case 5B). Voluntary interruption of pregnancy was performed in a patient exposed to etanercept for 4 weeks and with a previous daughter with Down syndrome (case 7). Complications during labor were reported in 2 of the pregnancies carried to term: respiratory distress in the newborn (case 4) and detachment of the amniotic sac (case 5B) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>). No fetal abnormalities were observed in either case.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The results found in the literature are presented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 2</a>. Ten patients with psoriasis were treated with biologic therapy during gestation. Six of these patients received ustekinumab: 1 with impetigo herpetiformis was treated up to week 26,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> 1 with recalcitrant pustular psoriasis and psoriatic arthritis received treatment for practically her whole pregnancy,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and the remaining 4 received ustekinumab accidentally during the first weeks of pregnancy.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> One of the patients was treated with adalimumab<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and another with etanercept<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> during the initial weeks of pregnancy, and 2 patients were prescribed treatment with infliximab throughout pregnancy.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> A normal pregnancy and delivery were observed in all but 2 patients: 1 with a spontaneous abortion,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and 1 with collodion baby.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Many reports have been published on pregnant patients with psoriatic arthritis, rheumatoid arthritis, or Crohn disease treated with biologic agents, but no previous case series or reviews have been published on patients with psoriasis treated with biologic therapy. Extrapolation of the results obtained in previous studies to patients with psoriasis would not appear wholly appropriate, as the characteristics, comorbidities, and idiosyncrasies of the diseases are different.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In 2009, a review was published of cases of congenital abnormalities reported to the FDA in children born to mothers who had received infliximab, etanercept, or adalimumab during pregnancy, independently of the underlying disease.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Among the 120<span class="elsevierStyleHsp" style=""></span>000 reported adverse reactions to these 3 drugs, the authors detected 41 cases of children born with congenital abnormalities. The main limitation of that study was that it did not enable incidences to be calculated, as the numerator (number of reported cases) was known but not the denominator (total population of pregnant women exposed to the drugs).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The results obtained in this review indicate a probable low risk of complications in women exposed to biologic agents during pregnancy, making the study somewhat reassuring for women accidentally exposed to these drugs. The decision to use this type of therapy during pregnancy must be made after appropriate evaluation of each case and determination of the risk-benefit ratio, that is, the balance between the importance of maintaining adequate control of the disease and the potential risk of fetal harm.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">BIOBADADERM is funded by the Spanish Academy of Dermatology and Venereology, by the Spanish Agency for Medicines and Healthcare Products, and by the pharmaceutical industry (Abbott, Merck-Schering Plough, and Pfizer-Wyeth). The participating companies each provide similar financial support and do not participate in the analysis or interpretation of results.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">A. Nuño-González has given lectures for Janssen Cilag, Roche, and IFC Cantabria.</p><p id="par0065" class="elsevierStylePara elsevierViewall">F. Vanaclocha has given lectures for Abbott, Pfizer, MSD, and Janssen.</p><p id="par0070" class="elsevierStylePara elsevierViewall">E. Daudén has undertaken the following activities: member of the Advisory Board, consultant, reception of grants, research support, participation in clinical trials, and receipt of fees for lectures given for the following pharmaceutical companies: Abbvie/Abbott, Amgen, Janssen Cilag, Leo Pharma, Novartis, Pfizer, MSD-Schering-Plough, Celgene, and Lilly.</p><p id="par0075" class="elsevierStylePara elsevierViewall">M. Alsina has acted as a consultant for Pfizer, Abbvie, Jannsen, and MSD.</p><p id="par0080" class="elsevierStylePara elsevierViewall">B. Pérez-Zafrilla has given lectures for Pfizer-Wyeth.</p><p id="par0085" class="elsevierStylePara elsevierViewall">I. Belinchón has acted as a consultant for Pfizer-Wyeth; Janssen Pharmaceuticals Inc., MSD, Almirall SA, and Leo-Pharma, and has given lectures for AbbVie, Pfizer-Wyeth, Janssen Pharmaceuticals Inc., and MSD.</p><p id="par0090" class="elsevierStylePara elsevierViewall">J. Sánchez-Carazo has acted as a consultant for AbbVie Laboratories, Janssen Pharmaceuticals Inc., MSD, and Pfizer-Wyeth.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The remaining authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of Interest" ] 2 => array:2 [ "identificador" => "xack269966" "titulo" => "Acknowledgments" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Echeverría-García B, Nuño-González A, Dauden E, Vanaclocha F, Torrado R, Belinchón I, et al. Serie de casos de pacientes psoriásicas expuestas a terapia biológica durante el embarazo. Registro BIOBADADERM y revisión de la literatura. Actas Dermosifiliogr. 2017;108:168–170.</p>" ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">The names of the members of the BIOBADADERM Study Group are listed in Appendix A.</p>" "identificador" => "fn1" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0105" class="elsevierStylePara elsevierViewall">Gregorio Carretero, Carlos Ferrandiz, José Manuel Carrascosa, Raquel Rivera, Francisco José Gómez García, Pablo de la Cueva, Enrique Herrera, José Luis López Estebaranz, Mercè Alsina, José Luis Sánchez Carazo, and Marta Ferrán.</p>" "etiqueta" => "Annex 1" "titulo" => "The BIOBADADERM Study Group" "identificador" => "sec0015" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Complications</th><th class="td" title="table-head " align="left" valign="top" scope="col">Maternal age, y \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biologic agent \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration of Exposure, wks \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Traditional Systemic Agent<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration of Exposure, wks \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pregnancy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Deliver \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prednisone 40<span class="elsevierStyleHsp" style=""></span>mg/d, Ciclosporin 300<span class="elsevierStyleHsp" style=""></span>mg/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Deterioration of the psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ciclosporin 300<span class="elsevierStyleHsp" style=""></span>mg/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adalimumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Azathioprine 100<span class="elsevierStyleHsp" style=""></span>mg/d, Prednisone 5<span class="elsevierStyleHsp" style=""></span>mg/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 and 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adalimumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adalimumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Systemic hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Respiratory distress of the newborn \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sciatic pain, erythema nodosum, nausea, asthenia, dizziness and vaginal infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Detachment of the amniotic sac \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ustekinumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Induced abortion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1352947.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The traditional systemic agents were administered after the systemic biologic agents.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">First pregnancy.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Second pregnancy.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pregnancies Recorded in the BIOBADADERM Register.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Implicated Drug \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Exposure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Puig et al., 2010<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Severe psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Throughout pregnancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal pregnancy/normal delivery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Borrego, 2010<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psoriasis and psoriatic arthropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Final dose: wk<span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal pregnancy/normal delivery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dessinioti et al., 2011<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adalimumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Final dose: wk<span class="elsevierStyleHsp" style=""></span>5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal pregnancy/delivery: low birth weight \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Andrulonis et al., 2012<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recalcitrant pustular psoriasis and psoriatic arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ustekinumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Throughout pregnancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal pregnancy/normal delivery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fotiadou et al., 2012<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ustekinumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Final dose: 4<span class="elsevierStyleHsp" style=""></span>wks preconception \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spontaneous abortion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sheeran et al., 2014<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recalcitrant psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ustekinumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Final dose: wk<span class="elsevierStyleHsp" style=""></span>4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal pregnancy/normal delivery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sheeran et al., 2014<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ustekinumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Final dose: wk<span class="elsevierStyleHsp" style=""></span>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pregnancy: outbreak of psoriasis in wk 34/normal delivery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Offiah et al., 2014<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psoriasis and psoriatic arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Throughout pregnancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal pregnancy/delivery: collodion baby \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rocha et al., 2015<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Severe psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ustekinumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Final dose: 18<span class="elsevierStyleHsp" style=""></span>d preconception \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal pregnancy/normal delivery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alsenaid et al., 2016<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psoriasis/impetigo herpetiformis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ustekinumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Final dose: wk<span class="elsevierStyleHsp" style=""></span>26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal pregnancy/normal delivery \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1352948.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Review of Cases in the Literature.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inadvertent pregnancy during ustekinumab therapy in a patient with plaque psoriasis and impetigo herpetiformis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 17 | 11 | 28 |
| 2024 Octubre | 111 | 65 | 176 |
| 2024 Septiembre | 108 | 22 | 130 |
| 2024 Agosto | 133 | 68 | 201 |
| 2024 Julio | 126 | 34 | 160 |
| 2024 Junio | 74 | 40 | 114 |
| 2024 Mayo | 85 | 71 | 156 |
| 2024 Abril | 99 | 38 | 137 |
| 2024 Marzo | 86 | 85 | 171 |
| 2024 Febrero | 65 | 36 | 101 |
| 2024 Enero | 73 | 35 | 108 |
| 2023 Diciembre | 76 | 24 | 100 |
| 2023 Noviembre | 82 | 38 | 120 |
| 2023 Octubre | 81 | 31 | 112 |
| 2023 Septiembre | 88 | 33 | 121 |
| 2023 Agosto | 62 | 21 | 83 |
| 2023 Julio | 76 | 44 | 120 |
| 2023 Junio | 63 | 28 | 91 |
| 2023 Mayo | 58 | 31 | 89 |
| 2023 Abril | 56 | 28 | 84 |
| 2023 Marzo | 85 | 54 | 139 |
| 2023 Febrero | 63 | 38 | 101 |
| 2023 Enero | 57 | 40 | 97 |
| 2022 Diciembre | 95 | 59 | 154 |
| 2022 Noviembre | 65 | 34 | 99 |
| 2022 Octubre | 40 | 30 | 70 |
| 2022 Septiembre | 38 | 39 | 77 |
| 2022 Agosto | 30 | 33 | 63 |
| 2022 Julio | 35 | 36 | 71 |
| 2022 Junio | 36 | 38 | 74 |
| 2022 Mayo | 72 | 34 | 106 |
| 2022 Abril | 70 | 42 | 112 |
| 2022 Marzo | 64 | 48 | 112 |
| 2022 Febrero | 78 | 54 | 132 |
| 2022 Enero | 67 | 58 | 125 |
| 2021 Diciembre | 78 | 54 | 132 |
| 2021 Noviembre | 98 | 58 | 156 |
| 2021 Octubre | 75 | 69 | 144 |
| 2021 Septiembre | 75 | 53 | 128 |
| 2021 Agosto | 66 | 54 | 120 |
| 2021 Julio | 55 | 45 | 100 |
| 2021 Junio | 63 | 30 | 93 |
| 2021 Mayo | 76 | 74 | 150 |
| 2021 Abril | 180 | 74 | 254 |
| 2021 Marzo | 106 | 49 | 155 |
| 2021 Febrero | 100 | 48 | 148 |
| 2021 Enero | 91 | 34 | 125 |
| 2020 Diciembre | 72 | 46 | 118 |
| 2020 Noviembre | 62 | 31 | 93 |
| 2020 Octubre | 34 | 23 | 57 |
| 2020 Septiembre | 61 | 31 | 92 |
| 2020 Agosto | 67 | 40 | 107 |
| 2020 Julio | 64 | 41 | 105 |
| 2020 Junio | 78 | 41 | 119 |
| 2020 Mayo | 64 | 36 | 100 |
| 2020 Abril | 38 | 15 | 53 |
| 2020 Marzo | 55 | 20 | 75 |
| 2020 Febrero | 7 | 2 | 9 |
| 2020 Enero | 2 | 0 | 2 |
| 2019 Diciembre | 2 | 0 | 2 |
| 2019 Noviembre | 2 | 0 | 2 |
| 2019 Septiembre | 3 | 0 | 3 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 2 | 0 | 2 |
| 2019 Junio | 2 | 0 | 2 |
| 2019 Mayo | 3 | 0 | 3 |
| 2019 Abril | 10 | 4 | 14 |
| 2019 Marzo | 2 | 0 | 2 |
| 2019 Febrero | 1 | 0 | 1 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 7 | 0 | 7 |
| 2018 Noviembre | 6 | 0 | 6 |
| 2018 Octubre | 24 | 0 | 24 |
| 2018 Septiembre | 15 | 0 | 15 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Febrero | 23 | 4 | 27 |
| 2018 Enero | 29 | 10 | 39 |
| 2017 Diciembre | 32 | 10 | 42 |
| 2017 Noviembre | 26 | 9 | 35 |
| 2017 Octubre | 22 | 9 | 31 |
| 2017 Septiembre | 28 | 8 | 36 |
| 2017 Agosto | 31 | 9 | 40 |
| 2017 Julio | 31 | 18 | 49 |
| 2017 Junio | 40 | 8 | 48 |
| 2017 Mayo | 40 | 19 | 59 |
| 2017 Abril | 36 | 30 | 66 |
| 2017 Marzo | 141 | 59 | 200 |
| 2017 Febrero | 14 | 22 | 36 |
| 2017 Enero | 5 | 14 | 19 |
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