Practical use of biologic therapy in dermatology: Some considerations and checklists

Abstract

Practice varies with respect to biologic therapy counseling and monitoring of biologic therapy. Because of the complexity, many physicians shy away from prescribing biologic therapy. To create checklists and discuss considerations behind various counseling and monitoring issues. The full prescribing information of infliximab, etanercept, adalimumab, golimumab, certolizumab, alefacept, ustekinumab, rituximab, and IVIg were reviewed in addition to National Psoriasis Foundation guidelines to create the checklists. Considerations of counseling for biologics includes explaining benefits, relative risks of not treating or alternative therapies, consequence of risk, preventability of risk, and likelihood of risk. Considerations regarding vaccination, viral hepatitis screening, tuberculosis screening, skin cancer screening, pregnancy, and anti-nuclear antibody screening are discussed. Consensus is unavailable as to the extent of counseling or monitoring. This manuscript provides one perspective. This article reviews monitoring and patient counseling considerations for the use of biologics in dermatology. Tables for each drug are provided with checklists for counseling and monitoring.