Magan Medical Clinic, Dermatology
We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:
If you have psoriasis or hair questions, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.
We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.
Same day appointments often available. No referral is necessary if you have PPO insurance. We accept a wide range of insurance plans (unfortunately, we do not accept Medi-Cal as primary insurance, only as secondary insurance).
For appointments, please call (626) 331-6411. We look forward to serving you!
"What’s New in..."
A monthly column by Dr. Chiang
What's New in Psoriasis
I usually post updates on new disease treatments. This month is unusual for instead discussing a new birth defect risk for etanercept (Enbrel), an injectable biologic medication used to treat moderate to severe psoriasis. Specifically, it may double the risk of major congenital defects. The FDA currently rates its safety in pregnancy as “B”, which is as safe a rating as I have seen in dermatology, other than folic acid (which is the only “A” I am aware of in dermatology). This means that the FDA believes animal studies show no risk of adverse effects but there are no adequate studies in pregnant women. However, a study of 370 women exposed to etanercept while pregnant has recently been reported to show a doubled risk of major congenital defects. This includes spine defects (spina bifida), heart defects (atrial septal defects), cleft palate, genital defects (hypospadias), extra finger or toe (polydactyly), and skull defects (craniosynostosis). Its main alternative adalimumab (Humira) hasn’t had full results yet reported but verbally “hasn’t found much to worry about.” Thus, with this new update, I may steer women with moderate-severe psoriasis who wish a systemic treatment to adalimumab (Humira) or another alternative if they may possibly become pregnant.
Currently, the doubled risk seems to have only been reported verbally by the Organization of Teratology Information Specialists (OTIS) at a rheumatology conference (annual meeting of the American College of Rheumatology) and in a publication reporting on the conference. OTIS’s own website on Enbrel hasn’t yet been updated with the information. Caveats were provided including “not meeting the criteria for causality” (not fitting normal teratogen pattern of also seeing reduced birth weights and spontaneous abortions) and “no biological plausibility” (since etanercept doesn’t seem to cross the placenta during the most vulnerable period for the fetus). However, I feel a doubled risk is large enough that the association is still something to consider.
If you have psoriasis, please make an appointment for dermatology consultation at (626) 331-6411 to discuss your options.
Charles Chiang, MD, FAAD
- Otto, A. Etanercept doubles risk of major malformations. Dermatology News 2016
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