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

J Am Acad Dermatol. 2015 Sep;73(3):420-8.e1. doi: 10.1016/j.jaad.2015.06.004. Epub 2015 Jul 14.


Background: Safety profiles of systemic biologic agents for the treatment of psoriasis and psoriatic arthritis (PsA) encompass a wide spectrum of adverse events. To date, no uniform evidence-based guidelines exist regarding screening and monitoring patients who are undergoing biologic therapy.

Objective: We sought to identify studies evaluating screening and monitoring tests in the treatment of psoriasis and PsA with systemic biologic agents, and to propose evidence-based practical guidelines.

Methods: The MEDLINE database was searched to identify data on risks associated with adalimumab, etanercept, infliximab, and ustekinumab. Articles were reviewed and graded according to methods developed by the US Preventative Services Task Force.

Results: Evidence was strongest (grade B) for tuberculosis screening. Interferon-gamma release assay was preferable to tuberculin skin testing. Among known hepatitis B virus carriers, the evidence grade was C for monitoring liver function tests and viral load.

Limitations: This study was limited by the lack of high-quality controlled trials evaluating screening and monitoring tests in patients treated with biologic agents.

Conclusions: Baseline tuberculosis testing remains the only screening test with strong evidence to support its practice. Other screening and monitoring tests commonly performed in patients who are taking biologic agents are supported only in certain clinical settings or lack evidence to support or recommend against their practice.

Keywords: adalimumab; biologics; etanercept; infliximab; monitoring; psoriasis; psoriatic arthritis; safety; screening; ustekinumab.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adalimumab / adverse effects
  • Adalimumab / therapeutic use
  • Arthritis, Psoriatic / diagnosis
  • Arthritis, Psoriatic / drug therapy*
  • Biological Factors / adverse effects
  • Biological Factors / therapeutic use*
  • Biological Therapy / adverse effects
  • Biological Therapy / methods
  • Evidence-Based Medicine
  • Female
  • Follow-Up Studies
  • Humans
  • Infliximab / adverse effects
  • Infliximab / therapeutic use
  • Male
  • Mass Screening / standards*
  • Mass Screening / trends
  • Monitoring, Physiologic / standards*
  • Monitoring, Physiologic / trends
  • Patient Safety
  • Practice Guidelines as Topic
  • Psoriasis / diagnosis
  • Psoriasis / drug therapy*
  • Reproducibility of Results
  • Risk Assessment
  • Treatment Outcome
  • Ustekinumab / adverse effects
  • Ustekinumab / therapeutic use


  • Biological Factors
  • Infliximab
  • Ustekinumab
  • Adalimumab