Priority 18 from the Psoriasis PSP

UNCERTAINTY: How do changes in female hormones, such as during puberty, pregnancy, miscarriage, menopause and contraceptive use, affect psoriasis and its treatment? (JLA PSP Priority 18)
Overall ranking 18
JLA question ID 0072/18
Explanatory note Not available for this PSP

Bobotsis, 2016 No clear evidence of increased adverse (pregnancy) outcomes in pregnant women with psoriasis.  Future research needed. 

Paziana 2013 Evidence that ciclosporin use during pregnancy may be a safe alternative for patients with autoimmune disease (including psoriasis) refractory to conventional treatment.  Further studies needed. 

Pottinger, 2018 This systematic review concluded that the potential effect of biologics on pregnancy outcomes specifically in women with psoriasis has not been adequately studied to quantify accurately.  Data on use in other indications is limited.  Women of child-bearing potential should be advised routinely to use regular contraception; however, when planning conception the risks and benefits of continuing vs. stopping therapy should be discussed on a case-by-case basis.  To address the clinical uncertainty, large disease-matched cohort studies are required, taking into account potential confounders such as disease activity, concomitant therapies and maternal demographics.  Psoriasis-specific pharmacovigilance registries, for example the British Association of Dermatologist Biologics Intervention Register (BADBIR) in collaboration with others via the European Psoriasis Registry Network (PSONET), provide opportunity to collate such data.

Health Research Classification System category Skin
Extra information provided by this PSP
Original uncertainty examples Do hormonal changes at puberty, pregnancy, menopause etc have any effect on the severity of psoriasis symptoms?
Submitted by 20 uncertainties were submitted around this question
PSP information
PSP unique ID 0072
PSP name Psoriasis
Total number of uncertainties identified by this PSP. 55  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 17 September 2018