31% of women of childbearing age prescribed teratogenic drugs for hidradenitis suppurativa

Key takeaways:

• 83% of women with hidradenitis suppurativa report not receiving physician-led counsel on how HS or medications could impact childbearing.
• 31% receive medications that are pregnancy category C or above.

Women of childbearing age with hidradenitis suppurativa are often prescribed teratogenic medications, and the majority do not receive physician-led counsel on how these medications could impact childbearing, according to published data.

“HS disproportionately affects women of childbearing age,” Gabrielle Marie Rivin, BA, MD, of the college of medicine at the University of Cincinnati, and Alan B. Fleischer, MD, of the department of dermatology at the University of Cincinnati, wrote in a letter published in Journal of Drugs in Dermatology.

However, 83% of women with HS of childbearing age did not receive counsel from their physician on how HS and their prescribed medications could affect childbearing, according to Rivin and Fleischer.

To investigate the treatment modalities most commonly used in women of childbearing age with HS, the researchers conducted a population-based, cross-sectional analysis of all medical visits of women aged 15 to 22 years with HS.

Of 43.8 million estimated total medical visits made by this group, the medical professionals seen most often were general and family practice doctors (28.6%), general surgeons (26.9%) and dermatologists (24.6%).

Only 1.84% of these visits were to obstetricians, meaning “it is the responsibility of primary care physicians, surgeons and dermatologists to facilitate conversations about potential pregnancy risk when prescribing HS therapy,” Rivin and Fleischer wrote.

Furthermore, of the visits where a practitioner prescribed medication, 31% involved medication that was a pregnancy C category or above, meaning risk cannot be ruled out or there is evidence of risk.

At 10% of prescriptions, the study found oral clindamycin to be the most commonly prescribed drug to women with HS. Although this drug lands in the pregnancy category B, it is not recommended in the first trimester of pregnancy due to lack of data. The second most common prescription, amoxicillin-clavulanate (7.04%), and the fourth most common, naproxen (5.06%), are also category B drugs.

Minocycline, the third most commonly prescribed drug at 6.8%, is a pregnancy category D medication meaning there is evidence of risk. Those risks include teratogenicity, teeth discoloration after in utero exposure and hepatotoxicity in pregnant women.

Trimethoprim-sulfamethoxazole, the fifth most commonly prescribed drug at 3.32%, is a pregnancy category C medication and increases the risk for neural tube defects, making it another drug that women of childbearing age should avoid.

The study further found that adalimumab, the only FDA-approved drug for HS, was only prescribed in 0.211% of visits. According to the authors, increasing the use of biologics such as adalimumab could help reduce the more than 31% of women of childbearing age with HS who are receiving medication deemed pregnancy category C or above.

However, since these teratogenic medications are the first-line therapy for mild to moderate HS, the authors hypothesize that practitioners will continue prescribing them.

“As many female patients feel that their physicians are not counseling them regarding the impact of HS therapy on childbearing, the results of this study serve as a reminder to dermatologists and non-dermatologists managing skin disease to continue to facilitate conversations about potential pregnancy risk when prescribing teratogenic medications in this population,” Rivin and Fleischer concluded.