In this SDPA interview, Murase provides tips for clinicians on conversations related to pregnancy, safety, and skin disease management.
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Jenny Murase, MD, speaking with the HCPLive editorial team at the
“I think one of the things we enjoy as dermatology providers is that connection that we establish with our patients with chronic skin disease,” Murase explained. “We take care of a lot of patients that are going to be on therapies for long periods of time, and when you look at how often a woman will become pregnant without talking to any health care professional, it's actually about 50%.”
Throughout the interview, she emphasized that dermatologists helping women of childbearing age should proactively discuss pregnancy planning when initiating systemic therapies rather than waiting for patients to raise the topic themselves. Research indicating that approximately half of pregnancies occur without prior discussion with a healthcare professional was cited by Murase, as well as data suggesting only a minority of patients consult a specialist prior to such circumstances.
Given such data, Murase noted her belief in the responsibilities of dermatology providers to prepare those they treat in advance, particularly those on systemic agents used for conditions such as psoriasis, acne, or atopic dermatitis. In her discussion, Murase noted her view suggesting patients should understand whether a treatment should not be continued, should be modified, or should be replaced if pregnancy takes place unexpectedly.
While she acknowledged the time constraints many clinicians face during busy clinic schedules, Murase believes these conversations to be an essential element of safe prescribing for women of reproductive age. Later, she also addressed 1 of the most common concerns among individuals on biologic therapy: whether continuing treatment during pregnancy places their baby at risk.
She noted that growing evidence, particularly in psoriasis, has become increasingly reassuring regarding the safety of many biologic agents during pregnancy. Noting her work leading a Delphi consensus for the National Psoriasis Foundation (NPF), she highlighted earlier concerns surrounding fetal immunosuppression, infections of newborns, and impaired vaccine responses and noted they have been shown to be less significant than initially feared for a wide array of drugs.
During patient counseling, Murase finds it helpful to explain the biology underlying placental antibody transfer. She noted that meaningful transfer of IgG-based biologics occurs primarily during the late third trimester through active transport across the placenta, while transfer during the first trimester, when organogenesis takes place, is minimal.
A comprehension of this timeline can often reassure patients in clinical settings regarding inadvertent exposure early in pregnancy. It is unlikely to raise their risk of congenital abnormalities, she stated. Murase did note, however, the need for special consideration of infants exposed to TNF inhibitors due to the rare but well-documented concern surrounding administration of the live BCG vaccine in tuberculosis-endemic regions.
Disclosures: Murase has previously reported serving on the speakers board for AbbVie, Galderma, LEO Pharma, Lilly, Pfizer, Regeneron, Sanofi, and UCB; on advisory boards for Arcutis, Blueprints Medicine, Bristol Myers Squibb, Galderma, LEO Pharma, Lilly, Pfizer, Regeneron, Sanofi, and UCB; and providing dermatologic consulting services for AbbVie, Apogee Therapeutics, Attovia, Galderma, Lilly, Regeneron, Sanofi, UCB, and UpToDate.
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