Analysis: Inconsistent Pretreatment Testing for Inflammatory Skin Diseases

A new analysis of US commercial insurance claims databases indicated that less than 60% of people living with chronic inflammatory skin diseases (CISD) receive recommended pretreatment testing.

The study, spanning from December 31, 2002, to December 31, 2020, sought to examine the prevalence of pretreatment testing in CISD, which included conditions such as psoriasis, hidradenitis suppurativa, or atopic dermatitis. The study sample included 122,308 adult patients with CISD initiating immunomodulatory treatment (including a variety of agents, such as methotrexate, tumor necrosis factor α inhibitors, interleukin (IL)–17Ai, ustekinumab, IL-23i, dupilumab, or apremilast). The primary outcome of interest was the proportion of patients undergoing suggested screening tests within six months before and during the initial two years of treatment.

According to the results, less than 60% of patients received the recommended pretreatment testing. Complete blood cell count emerged as the most common test, and was performed in 41% to 69% of individuals before initiation across treatments. Tuberculosis screening within six months before treatment ranged from 11% to 59%, with only 3% to 26% undergoing updated tests a year later. Hepatitis panels were conducted in 13% to 41% of cases before treatment. The authors also reported low pretreatment levels prior to apremilast, which persisted a year into treatment; a similar finding was reported with dupilumab.

“The variations in laboratory monitoring practices highlight a divergence from existing testing guidelines; therefore, future work should evaluate whether differential monitoring affects patient outcomes,” the authors concluded.

Source: Schneeweiss MC, Shay D, Ly S, et al. Prevalence of Pretreatment Testing Recommended for Patients With Chronic Inflammatory Skin Diseases. JAMA Dermatology. Published online January 31, 2024. doi:https://doi.org/10.1001/jamadermatol.2023.5895