ABSTRACT
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.
Subject(s)
Arthritis, Psoriatic/drug therapy , Biological Factors/therapeutic use , Mass Screening/standards , Monitoring, Physiologic/standards , Psoriasis/drug therapy , Adalimumab/adverse effects , Adalimumab/therapeutic use , Arthritis, Psoriatic/diagnosis , Biological Factors/adverse effects , Biological Therapy/adverse effects , Biological Therapy/methods , Evidence-Based Medicine , Female , Follow-Up Studies , Humans , Infliximab/adverse effects , Infliximab/therapeutic use , Male , Mass Screening/trends , Monitoring, Physiologic/trends , Patient Safety , Practice Guidelines as Topic , Psoriasis/diagnosis , Reproducibility of Results , Risk Assessment , Treatment Outcome , Ustekinumab/adverse effects , Ustekinumab/therapeutic useABSTRACT
Vitiligo after trauma through koebnerization is a widely reported phenomenon. Herein we present a case of vitiligo in an area of chronic cheilitis after isotretinoin treatment.
