Biologics: Targets & Therapy (Nov 2020)
Fetal Acrania (Exencephaly) in the Context of a Pregnant Female Taking Adalimumab for Psoriasis: A Case Report
Abstract
Nujud Daham,1 Abdullah AlMuqrin,2 Abdulaziz Madani,3 Fahad AlSaif3 1Department of Dermatology, Dr. Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia; 2Department of Dermatology, Prince Mohammed Bin Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Nujud DahamDepartment of Dermatology, Dr. Sulaiman Al-Habib Medical Group, King Fahad Road, Olaya, Po Box 91877, Riyadh 11643, Saudi ArabiaTel +966 500211134Email [email protected]: Adalimumab is a fully human, recombinant, IgG1 monoclonal antibody that targets tumor necrosis factor-alpha (TNF-alpha). It has been established that adalimumab can cross the placenta and can be detected in the fetal circulation for up to 6 months postpartum. However, clinical studies have failed to show any consistent or specific adverse fetal outcomes from maternal exposure to adalimumab during pregnancy. In our report, we present a case of fetal acrania (exencephaly) in the setting of a pregnant female taking adalimumab prior to and during pregnancy. Exencephaly is a neural tube defect (NTD) that results from failure of closure of the neural fold. It is true that there were other risk factors that might have contributed to our patient’s unfortunate outcome. For example, she did not take folic acid supplementation prior to or during her pregnancy. Nonetheless, studies have shown that folic acid deficiency alone is not sufficient to lead to the development of NTDs. Our patient’s exposure to adalimumab during her pregnancy might have added to the risk in her situation. Our report aims to inform clinicians of that possible risk and to stimulate them to report any similar outcomes.Keywords: adalimumab, exencephaly, neural tube defects, pregnancy, psoriasis, TNF-α
