Tamizaje con algunos biologicos

Sylvia Hsu, MD, FAAD

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 U.S. Preventative Services Task Force (J Am Acad Dermatol. 2015;73(3):420-8.e1).

The highest evidence grade for screening studies was B, seen in the use of tuberculin skin testing (TST) and interferon-gamma release assay (IGRA). Based on the USPSTF grading system, it is recommended this screen be provided because there is high certainty that the net benefit is moderate, or medium certainty that the net benefit is moderate to substantial. IGRA is preferred over TST because of IGRA's higher sensitivity and specificity.

Although HBV screening with triple serology — hepatitis surface antigen (HBsAg), hepatitis surface antibody (HBsAb), and hepatitis core antibody (HBcAb) — is recommended, this is supported by only grade C evidence. The evidence supporting HCV screening is also grade C, indicating that there is moderate certainty that the net benefit of routine screening for HBV and HCV is small. Therefore, screening for HBV or HCV can be performed based on professional judgment and/or prior authorization requirement. There is also insufficient evidence to recommend these routine screening tests: HIV, ANA, CBC, LFTs, skin cancer screening, renal studies, pregnancy testing, dsDNA, CRP.

Baseline tuberculosis testing is the only screening test with strong evidence to support its practice. Other screening and monitoring tests that are often performed in patients who are taking biologic agents lack evidence to support their use.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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