Pre-Treatment Testing with Biologics Falls Short Save

US commercial insurance claim analysis of laboratory screening and monitoring practices in chronic inflammatory skin disease (CISD) patients shows that < 60% received the recommended pretreatment testing when starting systemic immunomodulatory treatment.

Laboratory screening for tuberculosis, hepatitis, and other conditions are often recommended before starting most systemic immunomodulatory agents chronic inflammatory skin diseases (CISD).  This analysis included US commercial insurance claims data from adults CISD patients (psoriasis, hidradenitis suppurativa, or atopic dermatitis) starting immunomodulatory treatment with either methotrexate, tumor necrosis factor α inhibitors, interleukin (IL)–17Ai, ustekinumab, IL-23i, dupilumab, or apremilast. Screening tests for tuberculosis, hepatitis, and liver function; complete blood cell counts; and lipid panels—were determined within 6 months before and during 2 years after treatment start.

From a total of 122 308 CISD patients starting systemic immunomodulatory treatment in the US, fewer than 60% received the recommended pretreatment testing.

TNFα inhibitors, ustekinumab, IL-17Ai, and IL-23i had the highest level and very similar patterns of testing; the most to least frequent tests were complete blood cell counts (62%-67%), tests for tuberculosis (46%-60%) and hepatitis (31%-40%), lipid panels (35%-36%), and liver function tests (22%-27%).

Conclusions and Relevance  In this descriptive analysis of patients with CISDs starting systemic immunomodulatory treatment in the US, less than 60% received the recommended pretreatment testing. Additional research is required to understand whether variations in testing affect patient outcomes.  

These observations fall far below societal recommendations for screening especially for TB, where TB screening is recommended for TNFα inhibitors, ustekinumab, IL-17Ai, IL-23i, but not apremilast.  It is unclear if these variances or omissions will affect patient outcomes.

An editorial in JAMA Dermatology accompanies this report.