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Pretreatment Testing Often Omitted in Chronic Inflammatory Skin Disease

Between 11 and 59 percent of patients had tuberculosis screening within six months before treatment

By Dermsquared Editorial Team | January 31, 2024

WEDNESDAY, Jan. 31, 2024 -- Patients with chronic inflammatory skin diseases (CISD) starting systemic immunomodulatory treatment often do not receive recommended pretreatment testing, according to a study published online Jan. 31 in JAMA Dermatology.

Maria C. Schneeweiss, M.D., from Brigham and Women's Hospital in Boston, and colleagues conducted a descriptive analysis of U.S. commercial insurance claims databases to examine the prevalence of pretreatment testing that is recommended for patients with CISD. Data were included for 122,308 adult patients with CISD (psoriasis, hidradenitis suppurativa, or atopic dermatitis) who started an immunomodulatory agent.

The researchers found that the most common test, performed in 31 to 69 percent of individuals before initiating treatments, was complete blood count. Tuberculosis screening within six months before treatment was performed in 11 to 59 percent of patients, and 3 to 26 percent had updated tests one year later. Before treatment, between 13 and 41 percent had hepatitis panels. Low pretreatment testing levels, seen before apremilast (15 to 45 percent), persisted one year into treatment (9 to 36 percent) and were similar to testing levels for dupilumab (11 to 41 percent and 3 to 25 percent, respectively).

"Collaboration between federal and professional associations would be greatly beneficial to update laboratory screening/monitoring guidelines for therapies on a scheduled basis," write the authors of an accompanying editorial. "This will likely help to unify our practice while keeping patients safe."

Several authors disclosed ties to the pharmaceutical industry.

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