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TB testing supported in patients using biologics for psoriasis, PsA

Evidence supported baseline tuberculosis testing in patients with psoriasis and psoriatic arthritis being treated with biologic agents, while other testing lacked evidence for support, according to recently published study results.

“No uniform evidence-based guidelines exist regarding screening and monitoring patients who are undergoing biologic therapy,” Christine S. Ahn, MD, of Wake Forest School of Medicine, and colleagues wrote.

The researchers searched the Medline database to find data on risks associated with Humira (adalimumab, AbbVie), Enbrel (etanercept, Amgen), Remicade (infliximab, Janssen Biotech) and Stelara (ustekinumab, Janssen Biotech) in the treatment of psoriasis and psoriatic arthritis (PsA). Standardized methods developed by the U.S. Preventive Services Task Force were used to review and grade articles.

There were 1,039 articles identified in the search, 145 were screened, and 26 studies were included for qualitative analysis. The strongest evidence (grade B) was found for tuberculosis screening in patients using biologic treatments, and interferon-gamma release assay was preferable to tuberculin skin testing because of its higher sensitivity and specificity.

Thirteen of the studies included patients with hepatitis B virus (HBV), hepatitis C virus and congestive heart failure. Monitoring liver function tests and viral load received a grade C in patients with HBV.

The researchers said the study was limited by a lack of standardized control trials to measure the use of screening and monitoring tests in patients undergoing biologic treatment.

“There is increasing evidence to support HBV screening in psoriasis and PsA patients and further refinement of management options based on specific HBV serology,” the researchers concluded. “The results of this study … ultimately conclude that physicians must use their judgment when screening and monitoring patients who are undergoing therapy with biologic agents.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.