The Impact of Comorbidities on Biologic Selection for Psoriasis

Conclusions

• Injection biologics have revolutionized psoriasis treatment and require careful patient selection based on comorbidities.
• Psoriatic arthritis is the most common comorbidity in psoriasis patients, with screening essential for early detection and treatment.
• Many biologics approved for psoriasis are also approved for psoriatic arthritis, aiding treatment options.
• Inflammatory bowel disease is associated with psoriasis, and while some biologics work for psoriasis, IL-17 inhibitors may exacerbate IBD.
• Hepatitis B and C screening is crucial before starting biologics, as reactivation risks vary by hepatitis type and treatment.
• TNF inhibitors pose a higher risk of tuberculosis reactivation in patients with hepatitis B and C, and caution is advised during treatment.
• Patients with moderate to severe congestive heart failure should avoid TNF inhibitors due to potential increased mortality risks.
• TNF inhibitors and biologic treatments are not recommended for multiple sclerosis patients due to safety concerns and potential worsened symptoms.
• Biologics can be used safely in well-controlled HIV patients, but collaboration with infectious disease specialists is necessary.
• There is limited data on the use of biologics in patients with a history of malignancy, but they can be safely used under oncologist supervision, particularly avoiding TNF inhibitors.