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.