For an article about how biologic therapies for psoriasis are far more expensive in terms of drug costs and they also come with a significant price tag for necessary lab work: From your experience, how do lab monitoring requirements influence treatment planning for patients with psoriasis, particularly those who are older or have multiple health conditions?

Good Day, In fact in practice we see that lab work plays a large role in the decision for biologic treatment in psoriasis which also includes older patients and those with other health issues. These drugs in themselves may be expensive what adds to the cost is the required lab work which also brings in another layer of complexity. For patients which have liver or kidney disease, or are on many medications, regular blood tests become a real issue. It is not just the labs that are the issue but the time, transport, and co-ordination they require. For many, which includes many older adults, this does in fact play a role in whether a bio is a doable long term option. While biologics do present great results we also have to look at the whole picture not just the drug but also the additional elements that go with it. If you decide to use this quote, I'd love to stay connected! Feel free to reach me at gregorygasic@vmedx.com and outreach@vmedx.com.

The drug, dose, and visit frequency is frequently determined by lab monitoring. Methotrexate requires frequent monitoring of liver enzymes and blood counts every 2 to 4 weeks initially (approximately 3 months) and then every 8 to 12 weeks. Cyclosporine requires regular creatinine monitoring and blood pressure monitoring every 2 weeks initially and then monthly, since kidney strain may manifest itself early. Acitretin needs lipid and liver enzymes after every 1-3 months and precaution in pregnancy when necessary. In an older adult with diabetes, hypertension, or chronic kidney disease the workload and risk profile of that may be more than convenience, and the plan could be shifted to the use of agents with lighter routine labs. Biologics (such as IL-17 or IL-23 blockers) generally require preliminary screenings of tuberculosis and hepatitis and significantly lower continued laboratory testing. Apremilast is frequently symptom based and less lab based. Integration of psoriasis labs with existing primary care testing minimizes trips to the clinic and enhances follow-up. Local draw stations or in-home phlebotomy is useful to patients with mobility restrictions. Unusual outcomes lead to evident responses including dose reduction, treatment hold or using a safer class. The aim is sustained disease management and a laboratory regimen that is aligned to the medical reality of the patient.