Medical Research: What is the background for this study? What are the main findings?
Dr. Huang: This particular study was an update of a previous study our group had published in 2008 (JAAD, 6/08). As the use of biologics in dermatology has increased dramatically in recent years, we wanted to evaluate the evidence for the screening and monitoring tests that are routinely performed for patients with psoriasis and psoriatic arthritis on biologic agents.
We found that current guidelines for screening and monitoring tests varied among various national organizations (Table 1) including the American Academy of Dermatology, Japanese Dermatology Association, European Academy of Dermatology and Venerology, and the British Association of Dermatologists. Using evidence grading based on methods developed by the US Preventative Services Task Force (USPSTF), we found that the evidence was strongest (Grade B) for tuberculosis screening. High level evidence was in general lacking for other routine screening and monitoring tests except in select populations (Table 2, Table 3).
Medical Research: What should clinicians and patients take away from your report?
Dr. Huang: In general, biologics are effective and safe treatment options for patients with psoriasis and psoriatic arthritis who are appropriate candidates for such therapy. The findings of this study may not necessarily be true for patients on biologics for other medical conditions like inflammatory bowel disease and rheumatoid arthritis. Currently the evidence is strongest for tuberculosis screening for patients with psoriasis and psoriatic arthritis who plan to start a biologic. Other screening and monitoring tests should be based on the provider’s assessment of a patient’s individual risk.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Huang: As public and private insurance carriers and other managed care organizations are looking more and more at cost-effective care, additional studies are needed to establish the evidence and need for screening and monitoring tests for other treatments and medical conditions.
J Am Acad Dermatol. 2015 Sep;73(3):420-428.e1. doi: 10.1016/j.jaad.2015.06.004. Epub 2015 Jul 14.
To test or not to test? An updated evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis and psoriatic arthritis.
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William W. Huang, MD, MPH (2015). How Many Screening Tests Are Needed For Psoriasis Patients on Biologics?