Liver Function Test Elevations Rare With Biologics in Psoriasis and HS

Real-world data from an academic medical center show most patients with psoriasis (PSO), psoriatic arthritis (PsA), and/or hidradenitis suppurativa (HS) have liver function test (LFT) monitoring after starting a biologic or oral targeted systemic treatment. Elevated LFTs and related treatment changes were rare. The retrospective cohort study included 393 adults, and the findings were presented in a poster at the 2026 Fall Clinical Dermatology Conference.¹

Rare cases of elevated liver transaminases have been reported with biologic and oral targeted systemic treatments, and LFT monitoring recommendations remain inconsistent. The investigators set out to describe real-world monitoring practices. They also assessed how often abnormal or elevated results led to treatment modifications.¹

Matthew G. Bowles, of Vanderbilt Specialty Pharmacy, and colleagues conducted a retrospective cohort study using electronic health record data from an academic medical center in the southeastern US. Adults initiating a biologic or oral targeted systemic treatment from January 2021 to June 2023 were eligible.¹

LFTs were quantified at baseline, defined as within 6 months of prescription, and at 12 months after initiation. Follow-up LFT assessments were analyzed with multivariable negative binomial regression.¹

The 393 patients had a median age of 50.1 years, and 62.3% were female. Most had PSO (86.3%), followed by PsA (64.4%) and HS (10.9%), and 59.8% had more than 1 diagnosis, typically PSO and PsA. Initiated treatments included tumor necrosis factor inhibitors (TNFi; 45.5%) and phosphodiesterase-4 inhibitors (PDE4i; 27.7%).¹

At baseline, 78.6% (309/393) of patients had LFT monitoring. During follow-up, 67.7% (266/393) had LFTs, with a median of 1.0 LFT (IQR, 1.0–2.0).¹

Liver Function Test Abnormalities, Elevations, and Treatment Modifications With Biologics

Among the 309 patients monitored at baseline, 48.2% (149/309) had at least 1 abnormal LFT, defined as outside the reference range. Another 0.7% (2/309) had at least 1 elevated LFT, defined as greater than 3 times the upper limit of normal (ULN). At follow-up, 51.9% (138/266) of monitored patients had at least 1 abnormal LFT, and 1.1% (3/266) had at least 1 elevated LFT.¹

Of 207 individual abnormal LFTs, 48.3% (100/207) resolved, with a median time to resolution of 151.0 days (IQR, 89.0–204.0). Treatment modifications due to LFT elevations occurred in 1 of 393 patients.¹

Patients receiving concurrent treatments (incidence rate ratio [IRR], 1.67; 95% CI, 1.35–2.06) had more frequent LFT monitoring. The same was true for patients with comorbidities (IRR, 1.25; 95% CI, 1.00–1.57). The investigators concluded most patients had at least 1 LFT in the first year of treatment, while elevations and treatment modifications were rare.¹

The findings add real-world context to inconsistent LFT monitoring recommendations for patients with PSO, PsA, and HS receiving biologic or oral targeted systemic treatments. The data come from a single academic medical center, and the study was retrospective in design.¹

Disclosure: The study was funded by UCB, with medical writing support provided by Costello Medical and Mac Medical Communications. Three coauthors are UCB employees and shareholders. Other authors disclosed research support or advisory roles with companies including Eli Lilly and Company, BeiGene, BridgeBio, Sanofi, Takeda, and UCB.¹

Reference

1. Bowles MG, Ndefo U, Lauterbach A, et al. Retrospective observation of liver function tests in biologic-treated patients with psoriasis, psoriatic arthritis, and/or hidradenitis suppurativa. Poster presented at: Fall Clinical Dermatology Conference 2026; October 8-11, 2026; Las Vegas, NV