To test or not to test? Revisiting the value of baseline screening and monitoring tests among biologic treatments for psoriasis using an evidence-based assessment

Background Additional biologic treatments for psoriasis have emerged. Biologic therapies have few side effects, and unnecessary testing may lead to higher costs and false positive test results. Objective The objective of this study was to evaluate the need for baseline screening/monitoring tests in psoriasis patients prescribed biologics. Methods The literature regarding monoclonal antibody treatments for plaque psoriasis was systematically reviewed and graded according to the US Preventative Services Task Force methods. Results Overall, biologic treatments for psoriasis carry minimal risks. The evidence supports an initial screening and monitoring for tuberculosis in patients treated with tumor necrosis factor-⍺ inhibitors. Testing for human immunodeficiency virus, hepatitis C virus, complete blood count, complete metabolic panel, congestive heart failure, malignancy, and pregnancy offers limited benefit. Patients treated with tumor necrosis factor-⍺ inhibitors may benefit from hepatitis B virus testing, while inquiry regarding symptoms of candidiasis and inflammatory bowel disease may be helpful for interleukin-17 inhibitor-treated patients. Limitations Data regarding some specific risks are not available for some biologic classes. Conclusion Most routine baseline screening and monitoring tests provide little to no benefit. Testing may be unnecessary and costly; clinicians are encouraged to use their clinical judgment before ordering tests for all biologic-treated patients.