Pretreatment testing rates for patients with skin diseases may diverge from guidelines

Key takeaways:

• Less than 60% of patients underwent the recommended pretreatment testing.
• Future testing is needed to determine if these rates of testing affect patient outcomes.

Data showed that not all patients with chronic inflammatory skin diseases undergo pretreatment testing before initiating systemic immunomodulatory therapies, despite current guidelines, according to a study.

“Over the past 2 decades, systemic immunomodulatory agents have played an increasing role in dermatologic practice,” Maria C. Schneeweiss, MD, of Harvard Medical School, the department of dermatology and the division of pharmacoepidemiology and pharmacoeconomics in the department of medicine at Brigham and Women’s Hospital and the department of epidemiology at the Harvard T.H. Chan School of Public Health, and colleagues wrote. “Out of concern that some immunomodulatory agents may reactivate tuberculosis or hepatitis B and C, or increase risk of infections, myelosuppression and hepatotoxicity, professional societies recommend screening for hepatitis B and C and latent tuberculosis before starting biologic immunomodulatory agents.”

According to the authors, a study from 2008 found that only 53% of patients were tested for TB before initiating tumor necrosis factor alpha inhibitors, begging the question: what are the current laboratory screening and monitoring practices in patients starting these types of treatments for chronic inflammatory skin diseases?

To find out, the authors conducted a descriptive analysis of U.S. commercial insurance claims databases from December 2002 to December 2020 for adults (n = 122,308) with psoriasis, hidradenitis suppurativa or atopic dermatitis.

Results showed that fewer than 60% of patients underwent the recommended pretreatment testing. Patients taking tumor necrosis factor alpha inhibitors, ustekinumab, interleukin-17Ai and IL-23i underwent the most testing and followed very similar patterns.

Overall, liver function tests were the least utilized (22%-27%) followed by hepatitis (31%-40%), lipid panels (35%-36%) and tuberculosis (46%-60%). Blood cell counts were tested the most (62%-67%).

“Although this practice represents a break from current recommendations, when taken in combination with higher rates of baseline testing in the 6 to 12 months before treatment initiation and the potential for additional laboratory testing in settings that are not captured by this dataset, the gap may not be as large as this estimate,” the authors explained.

On the other hand, the authors admit that the gap between the number of patients that were tested for blood cell counts vs. liver function, despite having almost identical monitoring recommendations, is quite large.

“Future research is required to understand whether variations in testing affect patient outcomes,” the authors concluded.