Resident Astronomer’s Pregnancy & Enbrel Dilemma
from Christy D.

Hi Ed:  Once again, I'm grounded by the psoriasis. I was doing pretty well with just UV light until December when it started to come back. My OB had taken me off the Enbrel when I became pregnant since it was still a new drug and made her nervous.

Now, for you psoriatic pregnant folks (or anyone else for that matter), don't do what I did. I said, well, it's only a few months. I can tough it out. It took about a month for me to become completely covered — even the palms of my hands and soles of my feet. I have quarter-sized blotches all over my face even. So at my last OB visit, the doc said I was obviously in a lot of pain (there seems to be some myth out there that psoriasis doesn't hurt. Psoriasis hurts!) so I had the OK to have my Enbrel back but it was my decision.

Enbrel is FDA category B, but I decided to take advantage of my university setting and tracked down a biochemist. We sat down and discussed Enbrel.

If any of you ever consider using Enbrel in pregnancy, here's what we concluded — your body treats Enbrel like an antibody. There is a blood barrier between you and your baby so that your immune system can't attack the baby. So the Enbrel should not be able to pass through to the baby. And for those interested in nursing, the Enbrel molecule is too big to transfer into breast milk and would be destroyed by the baby's digestive system even if it did.

So don't tough it out — the psoriasis can spread very fast because pregnancy messes with your immune system! –Christy D.

*****

Ed’s Response:  Thanks for the update, Christy.  I know you stopped using Enbrel with some trepidation and your decision to start using it again was obviously made after lots of thought.

I dug this out of the Raptiva U.S. prescribing literature...

Developmental toxicity studies have been performed in rats and rabbits at doses ranging from 60- to 100-fold higher than the human dose and have revealed no evidence of harm to the fetus due to ENBREL.  There are, however, no studies in pregnant women.  Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

The “only if clearly needed” phrase is most curious, isn’t it?  It surely sounds like a semantic C.Y.A. to me. 

I expect that over the next few years we will learn much about biologics and pregnancy because there will be many prospective mothers facing your dilemma. 

Please keep us apprised.  –Ed

P.S. – How’s the Euro50 telescope coming along?

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