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Should You Screen Patients While They are Using Biologics?

Systemic biologic agents (also referred to as biologics) are among the most frequently used systemic treatments for moderate to severe plaque psoriasis and psoriatic arthritis (PsA). Given the safety profiles for biologics encompass a wide range of side effects, including opportunistic infections, the reactivation of infections, malignancy, hepatotoxicity, and the exacerbation of comorbidities, the FDA recommends screening and monitoring in patients treated with systemic biologic agents. A recent study published in the Journal of the American Academy of Dermatology attempted to outline evidence-based practical guidelines for when these screenings may be indicated.

The researchers searched the MEDLINE database for studies pertaining to systemic biologic treatments and screening tests in the context of psoriasis and PsA. The resulting articles were reviewed and graded according to standardized methods developed by the US Preventative Services Task Force (USPSTF). Under these guidelines a grade of “A” indicates the USPSTF recommends the service due to a high certainty that the net benefit is substantial. A grade of “B” indicates that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Below the grades of “A” and “B” or “C” the USPSTF does not recommend the screening or service.

After the review of studies on biologics and screenings, the authors found that only screening for Tuberculosis reached the evidence threshold of a “B.” High-grade evidence was lacking to support other routine testing. Therefore, the authors recommend physicians should use their clinical judgement when screening and monitoring patients who are taking biologic agents.

Byline: Martha L. Sikes, MS, RPh, PA-C and Wendy Meltzer, MPH
Source: http://www.jaad.org/article/S0190-9622(15)01743-0/abstract

Adapted from the original article.

[image by Joessistah]




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