Are tests necessary for psoriasis patients treated with biologics?

Many routine baseline screening and monitoring tests show no clear benefit to psoriasis patients prescribed biologic treatments, according to a study.

The authors systematically reviewed literature on monoclonal antibody treatments for plaque psoriasis and graded studies using the US Preventative Services Task Force methods. They sought to assess the need for baseline screening/monitoring tests in psoriasis patients prescribed biologics.

Biologics used to treat psoriasis had minimal risks overall. The review yielded evidence supporting an initial screening and monitoring for tuberculosis in patients receiving tumour necrosis factor-⍺ inhibitors (TNFis). However, testing for human immunodeficiency virus, hepatitis C virus, complete blood count, complete metabolic panel, congestive heart failure, malignancy, and pregnancy had little to no benefit.

On the other hand, patients treated with TNFis may benefit from hepatitis B virus testing, while those treated with interleukin-17 inhibitors may find it useful to undergo inquiries regarding symptoms of candidiasis and inflammatory bowel disease.

“Most routine baseline screening and monitoring tests provide little to no benefit,” the authors said. “Testing may be unnecessary and costly; clinicians are encouraged to use their clinical judgment before ordering tests for all biologic-treated patients.”

This review is limited by the absence of data regarding specific risks for some biologic classes.