From the Guidelines
Before initiating etanercept for severe plaque psoriasis, a tuberculin skin test and a chest X-ray are recommended to screen for latent tuberculosis (TB) and assess for any prior TB infection, as TNF-alpha inhibitors can reactivate latent TB 1. The workup prior to initiating etanercept treatment should focus on minimizing the risk of reactivating latent infections, particularly TB, due to the immunosuppressive nature of TNF-alpha inhibitors.
- A chest X-ray is recommended to assess for any signs of prior TB infection or other pulmonary conditions that could be relevant to the patient's treatment plan 1.
- A tuberculin skin test is also recommended to screen for latent TB, as this is a critical step in preventing the reactivation of TB in patients starting anti-TNF-alpha therapy 1. The patient's history of residing in the United States for their entire life may influence the perceived risk of TB, but guidelines still recommend screening due to the potential for latent infection 1. It is essential to follow these recommendations to ensure patient safety and minimize the risk of adverse events associated with etanercept treatment.
- Other screening measures, such as complete blood count, liver function tests, and renal function tests, may also be considered as part of the comprehensive workup before initiating etanercept treatment.
- However, the primary concern prior to starting etanercept is the risk of TB reactivation, making the tuberculin skin test and chest X-ray the most critical components of the workup 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recommended Workup Prior to Initiating Etanercept Treatment
The following workup is recommended prior to initiating etanercept treatment for severe plaque psoriasis:
- Tuberculin skin testing (TST) is the currently recommended method for screening for latent tuberculosis (TB) infection 2
- A chest X-ray may also be performed as part of the screening process for TB 3
Rationale for Recommended Workup
The rationale for recommending TST and chest X-ray is based on the increased risk of developing active TB in patients treated with TNF-alpha inhibitors, such as etanercept 2, 4
- The use of TNF-alpha inhibitors has been associated with an increased risk of developing active TB, particularly in patients with latent TB infection 2
- Screening for latent TB infection prior to initiating etanercept treatment is crucial to prevent the development of active TB 2, 5
Additional Considerations
Additional considerations include: