Experts Question Tuberculosis Screening for Psoriasis Drugs
New guidance suggests patients starting certain biologics may avoid unnecessary testing that currently delays treatment.
Updated on Oct. 20, 2026 in Diabetes
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Should doctors prioritize clinical evidence when deciding if patients need routine medical screening?
The National Psoriasis Foundation and International Psoriasis Council are challenging the need for routine tuberculosis screening before starting IL-17 and IL-23 inhibitor treatments. This shift aims to reduce administrative delays and costs for patients who do not face the same TB reactivation risks as those on TNF inhibitor therapies.
Why it matters
Routine screening currently acts as a barrier to accessing effective psoriasis medications because it is based on protocols developed for different drug classes. Eliminating this requirement could streamline treatment timelines for patients and lower unnecessary healthcare system expenses.
A new clinical review of tuberculosis risk indicates there is no direct evidence linking IL-17 or IL-23 inhibitors to tuberculosis reactivation, unlike the established risks seen with TNF inhibitors. Researchers concluded that blocking these specific pathways does not impair host control of the infection.
The players
National Psoriasis Foundation
A national health organization focused on funding research, improving care, and advocating for people living with psoriasis and psoriatic arthritis.
International Psoriasis Council
A global community of dermatology experts and researchers dedicated to improving the health and quality of life for individuals with psoriasis.
The details
TNF inhibitors, a different class of biologics, can reactivate latent tuberculosis because the body requires TNF to contain the infection; in fact, TNF-deficient mice die from Mycobacterium tuberculosis. IL-17 and IL-23 inhibitors, however, function through different immune pathways that do not appear to jeopardize the host's ability to control tuberculosis. Consequently, the current requirement to test for TB before starting these medications is based on outdated protocols rather than current clinical data specific to these drug classes.
Timeline
October 20, 2026: The position statement was published.
Health Landscape
This move represents a shift toward more precise, evidence-based management of biologic therapies in dermatology. It contrasts sharply with the established legacy of protocols for TNF inhibitors, suggesting a broader evolution in how clinicians differentiate risks between diverse biologic mechanisms.
If you are prescribed IL-17 or IL-23 inhibitors, talk to your doctor about whether routine tuberculosis screening is necessary for your specific treatment plan. Clarifying these requirements may help you avoid unnecessary diagnostic testing before beginning your care.
The takeaway
Clinicians are increasingly questioning whether broad screening protocols for older biologic drugs are appropriate for newer, safer treatment classes. As guidelines evolve, patients should always verify the clinical necessity of pre-treatment screenings with their dermatologist.
Further reading
For more information on managing chronic autoimmune conditions, see our Diabetes section.
Live Poll
Should doctors prioritize clinical evidence when deciding if patients need routine medical screening?
