Challenging Recycled Dogma with Monitoring of Biologics and JAK Inhibitors

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Scott Elman, MD, to examine whether laboratory monitoring requirements for systemic dermatologic therapies reflect current evidence. With some prescribing recommendations rooted in data from more than a decade ago, the clinicians discuss where routine testing remains warranted, where it may be unnecessary, and how dermatologists can balance patient safety with the burden of excessive monitoring.

Dr Elman begins by examining laboratory monitoring practices for atopic dermatitis therapies, highlighting important distinctions between biologics targeting IL-4, IL-13, and IL-31 and Janus kinase (JAK) inhibitors. While routine laboratory monitoring may offer limited clinical value for certain biologics, JAK inhibitors warrant a different approach given their safety profiles. He discusses the rationale for baseline screening and follow-up testing, while questioning the value of repeated testing in patients without changes in risk factors or exposure.

The conversation then shifts to psoriasis, where recommendations for tuberculosis and hepatitis screening have historically been influenced by experience with tumor necrosis factor inhibitors. Dr Elman highlights emerging evidence and recent guidance challenging the need for routine tuberculosis testing with IL-17 and IL-23 inhibitors. The clinicians also clarify the distinction between hepatitis screening and liver function testing, emphasizing the importance of evaluating risk according to therapeutic class rather than applying uniform monitoring requirements.

Beyond laboratory testing, Drs Del Rosso and Elman explore the value of interdisciplinary collaboration when managing patients with complex comorbidities, including inflammatory bowel disease. They discuss how coordination with other specialists can support treatment decisions without unnecessarily limiting therapeutic options.

Tune in to the episode for a practical discussion of evidence-based laboratory monitoring, the potential consequences of unnecessary testing, and how individualized assessment, appropriate co-management, and attention to overall patient health can inform systemic treatment decisions in dermatology.