ReportFrom the Medical Board of the National Psoriasis Foundation: Monitoring and vaccinations in patients treated with biologics for psoriasis
Section snippets
Methods
Members of the Medical Board of the National Psoriasis Foundation were surveyed about their monitoring and vaccination practices before patients with psoriasis are started on biologics. The survey also asked about the type and frequency of monitoring performed during therapy. The results of those surveys are reported in a separate article and were used as a basis for a consensus conference of the Foundation's medical board.4 In preparation for our consensus conference, we reviewed medical
History and physical examination
The need for history and physical examination was assessed. Elements brought into focus included medical history for tuberculosis (TB) exposure, other chronic infections, malignancy, and a review of systems (specifically neurologic, cardiac, and musculoskeletal [psoriatic arthritis]). Neurologic history is relevant as tumor necrosis factor (TNF)-α inhibitors can rarely be associated with new onset or exacerbation of demyelinating diseases such as multiple sclerosis and should, therefore, be
Discussion
Most studies of monitoring and vaccination practices in patients treated with biologics are not evidence based, making it difficult to create monitoring guidelines. There are few double-blind, placebo-controlled studies to show that monitoring or vaccinations prevent complications or disease. Several well-done studies help us predict which interventions are likely to find abnormal results. For example, pivotal trials with biologics were large enough to detect small numbers of cases of
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Funding sources: None.
Disclosure: Dr Lebwohl has been a consultant for Abbott, Amgen, Astellas, Centocor, Genentech, and Wyeth; he has been a speaker for Abbott, Amgen, Astellas, Centocor, and Genentech. Dr Strober has been a speaker, advisor, consultant, and/or investigator for Abbott, Amgen, Astellas, Genentech, Centocor, and Wyeth. Dr Gelfand has been a consultant to Genentech, Centocor, Amgen, Wyeth, and Warner-Chilcott2, and has received grants from Biogen Idec, Amgen, Astellas, and Centocor. Dr Bagel has been a speaker for Amgen, Astellas, Genentech, and Abbott; he has been a clinical investigator for Centocor and Amgen. Dr Weinstein is an investigator for Abbott Labs, Amgen, Genentech, and Centocor. Dr Krueger has received fees as a consultant or advisory board member for Abbot, Almirall, Alza, Amgen, Astellas, Barrier Therapeutics, Boehringer-Ingelheim, Bristol-Myers Squibb, Centocor, Connetics, Genentech, Genzyme, L'Oreal, Magen Biosciences, MedaCorp, Medics, Novartis, Schering-Plough, Warner Chilcott, and ZARS. He owns equities and stock options in/from ZARS. In the last 24 months, Dr. Krueger has received lecture fees from Abbott, Amgen, Astellas, Boehringer-Ingelheim, Centocor, Connetics, and Warner Chilcott, and has received partial stipend support for a clinical research fellowship from Abbott, Amgen, and Centocor. Ms Young has been a consultant or speaker for Astellas, Abbott, Amgen, and Genentech. Dr Gordon has received research support and honoraria from, and has consulted for Abbott, Amgen, and Centocor. Dr Kalb has been an investigator and consultant for Abbott, Amgen, Centocor, and Genentech. Dr Hsu has served on advisory boards for Abbott, Centocor, Biogen Idec, Genentech, and Amgen and has been an investigator for Centocor and Amgen. Dr Mease has been an investigator, consultant, and speaker for Abbott, Amgen, Biogen Idec, Centocor, Genentech, and Wyeth. Dr Korman is an investigator, speaker, and consultant for Abbott, Astellas, Genentech; an investigator and speaker for Amgen; and an investigator and consultant for Centocor. Dr Kimball has been a consultant and investigator for Amgen, Centocor, and Abbott and has received a fellowship grant from Centocor. Dr Pariser has been an investigator and consultant for Abbott, Amgen, Astellas, Centocor, Genentech, and Warner Chilcott. Dr Gladman is a consultant for Abbott, Amgen, Bristol-Myers Squibb, Centocor, Schering, Wyeth, and has received grant support from Abbott Canada, Amgen-Wyeth Canada, Schering Canada, Pfizer Canada, and Wyeth Global for studies. Dr Van Voorhees has been an advisor for, and received honoraria from Amgen, Abbott, Centocor, and Genentech. Dr Paller has been a consultant for Astellas, Novartis, Amgen, and Johnson & Johnson, and has served on advisory boards for Astellas, Novartis, and Johnson & Johnson. Dr Ritchlin has been a consultant for Abbott, Wyeth, Amgen, Centocor, Biogen, and Genentech and has received research funding from Centocor. Dr Horn was an employee of the National Psoriasis Foundation. The National Psoriasis Foundation receives unrestricted funding from Abbott Immunology, Amgen and Wyeth, Astellas Pharma Inc, Barrier Therapeutics, Beiersdorf, Centocor, Daavlin, Galderma Laboratories, Genentech, National Biologic Corporation, Neutrogena, PhotoMedex, Stiefel Laboratories, and Warner Chilcott. Dr Morison has no conflicts of interest to declare.
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