Abstract
Background: Biologics are widely used in the treatment of psoriasis and psoriatic arthritis. Objective: Our aim was to arrive at a consensus on the kind of monitoring and the vaccinations that should be performed before and during biologic therapy. Methods: Medical literature and data presented at meetings were reviewed and a consensus conference was held by members of the Medical Board of the National Psoriasis Foundation. Results: Consensus was established on monitoring and vaccination practices that included discussion and recognition of variations in those practices. History, physical examination, chemistry screen with liver function tests, complete blood cell count, and platelet count and tuberculosis testing are widely obtained at baseline and with variable frequencies thereafter. Patients treated with efalizumab have platelet counts checked more often; liver function tests are repeated more frequently in patients treated with infliximab; patients taking tumor necrosis factor blockers undergo tuberculosis testing more often; and patients treated with alefacept have CD4 counts checked approximately every 2 weeks. Avoidance of live vaccines during biologic therapy and administration of essential vaccines before biologic therapy were discussed, although vaccination is performed only to a variable degree. There was no consistency in the measurement of antinuclear antibodies among the experts. Limitations: There are few evidence-based studies on monitoring practices for patients with psoriasis taking biologic therapies. Conclusions: In patients taking biologic therapies for psoriasis, monitoring of blood chemistries, blood counts, CD4 counts, antinuclear antibodies, tuberculin skin tests, history, and physical examination may be warranted depending on the particular therapy and the particular patient. Vaccination practices are also addressed.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 94-105 |
| Number of pages | 12 |
| Journal | Journal of the American Academy of Dermatology |
| Volume | 58 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2008 |
Funding
Disclosure: Dr Lebwohl has been a consultant for Abbott, Amgen, Astellas, Centocor, Genentech, and Wyeth; he has been a speaker for Abbott, Amgen, Astellas, Centocor, and Genentech. Dr Strober has been a speaker, advisor, consultant, and/or investigator for Abbott, Amgen, Astellas, Genentech, Centocor, and Wyeth. Dr Gelfand has been a consultant to Genentech, Centocor, Amgen, Wyeth, and Warner-Chilcott2, and has received grants from Biogen Idec, Amgen, Astellas, and Centocor. Dr Bagel has been a speaker for Amgen, Astellas, Genentech, and Abbott; he has been a clinical investigator for Centocor and Amgen. Dr Weinstein is an investigator for Abbott Labs, Amgen, Genentech, and Centocor. Dr Krueger has received fees as a consultant or advisory board member for Abbot, Almirall, Alza, Amgen, Astellas, Barrier Therapeutics, Boehringer-Ingelheim, Bristol-Myers Squibb, Centocor, Connetics, Genentech, Genzyme, L'Oreal, Magen Biosciences, MedaCorp, Medics, Novartis, Schering-Plough, Warner Chilcott, and ZARS. He owns equities and stock options in/from ZARS. In the last 24 months, Dr. Krueger has received lecture fees from Abbott, Amgen, Astellas, Boehringer-Ingelheim, Centocor, Connetics, and Warner Chilcott, and has received partial stipend support for a clinical research fellowship from Abbott, Amgen, and Centocor. Ms Young has been a consultant or speaker for Astellas, Abbott, Amgen, and Genentech. Dr Gordon has received research support and honoraria from, and has consulted for Abbott, Amgen, and Centocor. Dr Kalb has been an investigator and consultant for Abbott, Amgen, Centocor, and Genentech. Dr Hsu has served on advisory boards for Abbott, Centocor, Biogen Idec, Genentech, and Amgen and has been an investigator for Centocor and Amgen. Dr Mease has been an investigator, consultant, and speaker for Abbott, Amgen, Biogen Idec, Centocor, Genentech, and Wyeth. Dr Korman is an investigator, speaker, and consultant for Abbott, Astellas, Genentech; an investigator and speaker for Amgen; and an investigator and consultant for Centocor. Dr Kimball has been a consultant and investigator for Amgen, Centocor, and Abbott and has received a fellowship grant from Centocor. Dr Pariser has been an investigator and consultant for Abbott, Amgen, Astellas, Centocor, Genentech, and Warner Chilcott. Dr Gladman is a consultant for Abbott, Amgen, Bristol-Myers Squibb, Centocor, Schering, Wyeth, and has received grant support from Abbott Canada, Amgen-Wyeth Canada, Schering Canada, Pfizer Canada, and Wyeth Global for studies. Dr Van Voorhees has been an advisor for, and received honoraria from Amgen, Abbott, Centocor, and Genentech. Dr Paller has been a consultant for Astellas, Novartis, Amgen, and Johnson & Johnson, and has served on advisory boards for Astellas, Novartis, and Johnson & Johnson. Dr Ritchlin has been a consultant for Abbott, Wyeth, Amgen, Centocor, Biogen, and Genentech and has received research funding from Centocor. Dr Horn was an employee of the National Psoriasis Foundation. The National Psoriasis Foundation receives unrestricted funding from Abbott Immunology, Amgen and Wyeth, Astellas Pharma Inc, Barrier Therapeutics, Beiersdorf, Centocor, Daavlin, Galderma Laboratories, Genentech, National Biologic Corporation, Neutrogena, PhotoMedex, Stiefel Laboratories, and Warner Chilcott. Dr Morison has no conflicts of interest to declare.
ASJC Scopus subject areas
- Dermatology
