precautions that should be taken before starting any biologics
• Establish and record disease activity.
• Screen for comorbidities: skin examination for malignancy, infection risk, human immune deficiency virus (HIV) risk factors, hepatitis B/C risk factors, history of malignancy (lymphoma, melanoma, others), history of demyelinating disease, history of tuberculosis (TB) or other mycobacterial infections, history of fungal exposure, hyperlipidemia, liver disease, pregnancy, medications.
• Vaccination status: patients should receive inactivated influenza vaccine (seasonal), human papilloma virus vaccine, and age-appropriate pneumococcal and herpes zoster vaccines. Hepatitis B virus vaccination for at-risk patients.
• Tests before use: complete blood count (CBC), creatinine, hepatic enzymes, lipids, C-reactive protein, hepatitis B and C serologies, purified protein derivative (PPD) (or interferon [IFN]-γ release assay [IGRA]), chest x-ray, HIV (if risk factors).