Rare Liver Function Test Elevations in Psoriasis and HS Patients on Biologics
Why this matters
If you have psoriasis, psoriatic arthritis, or hidradenitis suppurativa and your doctor has suggested a biologic or an oral targeted medicine, you may wonder whether your liver needs extra monitoring. A recent real-world review from a single academic medical center looked at how often people on these treatments had liver tests and whether abnormal results led to treatment changes. (Source: Bowles et al., Fall Clinical Dermatology Conference 2026)
Quick summary
The study followed 393 adults who started a biologic or an oral targeted treatment between January 2021 and June 2023. Most people had at least one liver test in the first year after starting treatment. Serious liver test elevations were uncommon, and treatment changes because of liver test results were very rare.
What the researchers looked at
The team used electronic health records to find adults who began a biologic or oral targeted systemic therapy for psoriasis (PSO), psoriatic arthritis (PsA), or hidradenitis suppurativa (HS) during the study period. They checked liver tests done within six months before the prescription (baseline) and tests up to 12 months after starting the drug. (Source: Bowles et al., Fall Clinical Dermatology Conference 2026)
Who was in the study
There were 393 people in total. The median age was about 50 years and 62% were female. Most had psoriasis (86%), many also had psoriatic arthritis (64%), and 11% had hidradenitis suppurativa. About 60% had more than one of these conditions. Treatments started included tumor necrosis factor inhibitors (TNFi) for 45.5% of people and phosphodiesterase-4 inhibitors (PDE4i) for 27.7%.
What the study found
At baseline, 78.6% (309 of 393) had at least one liver function test. During the year after starting treatment, 67.7% (266 of 393) had at least one follow-up liver test; the typical person had one test during that time (median 1.0, interquartile range 1–2).
“Abnormal” liver tests here meant results outside the lab’s normal range. Nearly half of people monitored at baseline (48.2%, 149 of 309) had at least one abnormal result. Most of those abnormalities were mild. “Elevated” tests in this study were defined as more than three times the upper limit of normal (ULN), which would be more concerning; this happened in 0.7% (2 of 309) at baseline and in 1.1% (3 of 266) during follow-up.
Looking at each abnormal test result (207 results in total), nearly half (48.3%, 100 of 207) returned to normal on their own, with a median time to resolution of about 151 days (about five months).
Only 1 out of the 393 people had a treatment change because of a liver test elevation. People who were taking other treatments at the same time had liver tests more often (incidence rate ratio 1.67), and people with other medical problems also had somewhat more frequent testing (IRR 1.25). (Source: Bowles et al., Fall Clinical Dermatology Conference 2026)
What this means for patients
The main takeaway is that in this single-center review, most people starting these therapies had at least one liver test in the first year, but serious liver enzyme rises were uncommon and almost never led to stopping or changing treatment. This adds some real-world context to the fact that guidelines about how often to check liver tests vary.
Keep in mind that small, mild liver test abnormalities are fairly common and often get better without major changes. Tests more than three times the upper limit of normal were rare in this group.
When to talk with your doctor
If you’re starting a biologic or an oral targeted medicine, ask your clinician how often they recommend liver testing and why. Also contact your care team right away if you develop symptoms that could suggest liver trouble, including:
- Yellowing of the skin or eyes (jaundice)
- Dark urine or pale stools
- Abdominal pain or persistent nausea
- Unusual fatigue or weakness
These symptoms could signal a problem and need prompt medical attention. Treatment decisions should always be discussed with your doctor or dermatologist.
Tracking visible skin changes
If you’re watching how your skin responds to treatment, keeping photos or notes about new or changing lesions can be helpful when you talk with your clinician. This can make it easier to describe what you’ve noticed between visits.
Limitations to keep in mind
This study looked back at records from one academic medical center, so results may not reflect what happens everywhere. It was a retrospective review, meaning it used existing records rather than following people prospectively. The study was funded by UCB, and some authors are UCB employees or reported ties to pharmaceutical companies; the investigators noted these disclosures. These factors don’t invalidate the findings but are important context when interpreting the results. (Source: Bowles et al., Fall Clinical Dermatology Conference 2026)
Disclaimer
This article is for information only and is not medical advice. Talk with your doctor about monitoring and treatment choices that suit your health needs. If you have worrying symptoms, seek care promptly.
Sources
- 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. (Source: Bowles et al., Fall Clinical Dermatology Conference 2026)