Table 4.

Immunologic Complications and Recommended Management Strategies

Therapeutic Target	Drug Immunogenicity	Lupus-like	Demyelinating	Psoriasis
TNF	High Aba: Stop Low Ab: Add IMM and/or increase drug	Stop Switch to a non-anti-TNF	Stop Switch to a non-anti-TNF	Mildb: Continue anti-TNF, Treat topically, +/-methotrexate Severe: Stop and Treat, +/- methotrexate, Switch to non-anti-TNF
Integrin	Continue	N/A	Continue	Continue
IL 12/23	Continue	N/A	Continue	Effective Treatment for anti-TNF psoriasis
JAK	N/A	N/A	Continue	Continue

IL: interleukin; JAK: Janus kinase; IMM: immunomodulator

^aAntibody concentration interpretation depends on the assay utilized (ELISA vs radioimmune vs mobility shift) and no standard criteria have been defined. A cutoff of <8 µg/mL for low and ≥8 µg/mL for ELISA has been described for inflixiamb.⁷⁷ The authors recommend providers utilize a single laboratory consistently and become familiar with the range and interpretation of results.

^bMild dermatologic reactions defined as those encompassing <5% total body surface area, tolerable to patient, and not rapidly expanding. Severe reactions involve ≥5% body surface, are intolerable to the patient, or quickly enlarging.⁷⁸