Optimizing Outcomes When Using Biologics for Treatment of Psoriasis - Episode 7

Infectious Diseases and Biologic Treatment Selection

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Experts emphasize the importance of collaboration with infectious disease specialists for patients with tuberculosis, while highlighting the low reactivation rates in newer agents.

In patients with a positive test for tuberculosis (TB), the experts discuss their approach to treatment initiation with IL-17 and IL-23 blockers. They note that while TB monitoring remains a standard practice, the risk of TB reactivation with these biologics is low based on available evidence. Annual TB testing is not routinely recommended after treatment initiation due to the lack of signal for TB reactivation in meta-analyses of IL-17 and IL-23 blockers.

Regarding patients with a positive TB test and negative chest X-ray, they emphasize the importance of individualized patient care and collaboration with infectious disease specialists. Waiting for TB prophylaxis to take effect, typically four weeks, before starting systemic agents for psoriasis is considered prudent; in urgent cases such as active psoriatic arthritis, treatment initiation may be expedited. For patients with active TB, the experts recommend initiating anti-TB treatment and waiting before considering systemic biologic therapy. They highlight the need to adhere to label recommendations, which advise against starting biologics during active infections. Overall, their approach prioritizes patient safety and adherence to established guidelines while ensuring timely and effective management of psoriasis and psoriatic arthritis.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.