Practical Management and Monitoring of Psoriasis Patients on Biologic Therapy: A Survey of Opinion Leaders and Practitioners

Abstract

Objective

To provide practical guidance to dermatologists on how to monitor psoriasis patients on biologic therapies.

Design

Survey of health care providers on monitoring and vaccination practices in patients on biologic therapies.

Participants

21 present and former members of the Medical Board of the National Psoriasis Foundation.

Results

The survey revealed a wide variety of practices, but some general trends emerged. Most of the experts who were surveyed checked screening hematology with all of the drugs and continued to check it every two to six months. CD4+ counts were only checked with alefacept and were generally taken at screening and at least every two weeks. Serum chemistry and liver function monitoring were usually checked at screening and then every two to six months, especially in patients on infliximab. Most of the practitioners surveyed did not check for antinuclear antibodies (ANA) at screening. However, approximately one-third did screen for ANA in patients on tumor necrosis factor (TNF)-blocking agents; only a few continued to check it every three to six months. Tuberculosis screening was generally done for patients on all of the biologic therapies, but was almost universally done in patients treated with TNF-blocking drugs. Yearly tuberculin skin testing was continued by approximately two-thirds of the practitioners. Approximately half of respondents gave influenza vaccines to patients on biologic therapy.

Conclusions

Currently there are no guidelines for the monitoring of patients on biologic therapy and there is a lack of consistency among practitioners. However, medical literature provides a great deal of information on which to base monitoring practices. Monitoring and vaccination practices should vary from patient to patient depending on many factors, so these findings should not be viewed as guidelines.