Le choix thérapeutique : médicaments du psoriasis et grossesse avant, pendant et après la grossesse

Treatment of cutaneous psoriasis before, during and after pregnancy

Résumé

Le psoriasis touche généralement des adultes jeunes, et donc de nombreuses femmes avec désir de grossesse ou enceintes. Le traitement peut alors s’avérer être un véritable défi chez certaines patientes, surtout en cas de formes sévères. Au-delà des traitements locaux, généralement bien tolérés, la photothérapie à ultraviolets B et la ciclosporine restent les traitements systémiques de première intention. L’acitrétine et le méthotrexate sont formellement contre-indiqués. Les données concernant les biothérapies prises en cours de grossesse sont rassurantes, le principal risque étant l’immunodépression du nouveau-né en cas de maintien du traitement. Les biothérapies doivent idéalement être interrompues en amont de la grossesse, mais, en cas d’absolue nécessité, elles peuvent être maintenues voire initiées au cours de la grossesse. Dans tous les cas, il est recommandé de ne pas maintenir une biothérapie au-delà du second trimestre, en raison du risque d’infection materno-fœtale. En cas d’initiation d’une biothérapie au cours de la grossesse, l’étanercept ou le certolizumab seront privilégiés, en raison de leur faible passage transplacentaire et d’un plus grand recul sur leur sécurité d’administration au cours de la grossesse.

Abstract

Psoriasis typically affects young adults and therefore many women with a desire to become pregnant or already pregnant. In this particular situation, treatment can be a real challenge for some patients, especially in the case of severe forms. In addition to local treatments, which are generally well tolerated, UVB phototherapy and cyclosporin remain the first-line systemic treatments. Acitretin and methotrexate are contraindicated. Safety data regarding the administration of biologic agents during pregnancy, are reassuring, the main adverse event being immunosuppression of the newborn iftreatment is not discontinued. Biologic agents should ideally be discontinued before pregnancy, but in case of absolute necessity, they can be maintained or even initiated during pregnancy. Overall, it is recommended that biologic agents should not be continued beyond the second trimester because of the risk of maternal-fetal infection. If a biologic agent should be initiated during pregnancy, etanercept or certolizumab will be preferred, because of their low transplacental passage and more extensive safety data.

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Correspondence to Axel P. Villani.

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AV est consultant pour Janssen et Novartis

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Villani, A.P. Le choix thérapeutique : médicaments du psoriasis et grossesse avant, pendant et après la grossesse. Eur J Dermatol 30, 8–13 (2020). https://doi.org/10.1684/ejd.2020.3884

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Mots clés

  • psoriasis
  • grossesse
  • allaitement
  • tératogénicité
  • agents biologiques
  • contamination materno-fœtale

Key words

  • psoriasis
  • pregnancy
  • breast feeding
  • teratogenicity
  • biologic agents
  • maternal-fetal infection