Biologics monitoring: incongruity between recommendations and clinician monitoring trends

Abstract

Background: Biologics are commonly used for moderate to severe psoriasis. Monitoring laboratory tests may provide little definitive benefit to patients.Objective: We queried a Humana database to gain insight regarding dermatologists' laboratory monitoring practices for psoriasis patients on biologics.Methods: Data were obtained from the Humana database. Our cohort included 333 patients with primary ICD-9 diagnosis of psoriasis (696.1) between the years 2008 and 2013 who are prescribed any biologic medication. Subjects on methotrexate, acitretin, or cyclosporine were excluded from the study. We separately queried laboratory tests by CPT codes and quantified based on frequency over a 2-year time period. Percentages of demographic group receiving a laboratory test at a given frequency category were calculated.Results: About 46% and 47% of patients received >4 comprehensive metabolic panel and complete blood count tests 2 years after starting a biologic. About 18% of individuals age >50 received greater than four Basic Metabolic Panel tests 2 years after starting a biologic.Limitations: Patient comorbidities might confound some of our findings, as these laboratory tests may have been ordered for a comorbidity rather than for biologics side effect monitoring.Conclusions: There are inconsistencies between current monitoring practices and guidelines. Clarifying biologics monitoring recommendations in psoriasis patients may reduce healthcare costs and provider workload.