COMMENTARY

Monitoring Biologic Therapy in Psoriasis and Psoriatic Arthritis

Which Tests Have the Most Value?

Graeme M. Lipper, MD

Disclosures

October 27, 2015

Viewpoint

Ahn and colleagues set out to update monitoring recommendations for patients with psoriasis who are on long-term biologic therapy. Of note, they did not include data from such IL-17 antagonists as secukinumab. Furthermore, their results do not establish any recommended frequency for testing, although most consensus panels recommend biannual laboratory monitoring.

This study confirmed the importance of tuberculosis screening for all patients before starting and during therapy with infliximab, etanercept, adalimumab, or ustekinumab. There was also increasing evidence to support HBV screening. Although evidence supporting screening for HCV was less compelling, the investigators still advocated checking baseline HCV serology, with hepatic function monitoring for patients with a history of liver disease.

The most intriguing outcome of this study is the idea that clinicians are probably ordering far too many monitoring tests for patients on biologic therapy. This is compounded by the fact that these treatments are designed for long-term use, in many cases for the lifetime of the patient.

Current guidelines[2,3,4] support extensive laboratory tests every 6 months (CBC with differential, liver function tests, metabolic panel, C-reactive protein, creatinine clearance) in all patients taking biologics for psoriasis and psoriatic arthritis, but with the exception of tuberculosis screening, none of these tests have been shown to protect against any adverse outcomes. By eliminating unnecessary testing and tailoring tests to the individual patient on the basis of his or her medical history and risk factors, clinicians can reduce unnecessary medical expenses. This "smart" approach to testing will also reduce patient anxiety caused by false-positive results or clinically irrelevant laboratory abnormalities.

Abstract

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