The Treatment of Moderate-to-Severe Psoriasis: Prescreening and Monitoring Psoriatic Patients on Biologics

The development of biologics has dramatically altered the treatment of moderate-to-severe psoriasis while also introducing new standards of care for therapeutic monitoring. Currently, the biologics approved by the US Food and Drug Administration are divided into 3 classes: T-cell modulators, tumor necrosis factor-alpha inhibitors, and interleukin-12/23 inhibitors. Although the US Food and Drug Administration has established recommendations for pre- and peri-treatment screening evaluations, much of the evidence comes from clinical trials evaluating the short-term safety and efficacy of each medication, rather than long-term data, or studies that summarize either the appropriateness or feasibility of screening. Instead of following a blanket algorithm, providers must understand the evidence as it relates to each medication to determine which tests are appropriate for any specific patient. This chapter summarizes the current body of evidence and recommends a practical approach for monitoring psoriasis patients who are receiving biologic therapies.