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Biologic Half-Life Surgery — SCE Dermatology MCQ

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ModerateDermatopharmacologyBiologic Half-Life SurgerySCE Dermatology

A 55-year-old man with psoriasis has been on a biologic for 2 years. He is due for elective surgery. His surgeon asks about the biologic's half-life to determine when to withhold treatment. Why is the drug half-life important perioperatively?

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Correct answer: B — The drug should be withheld for 3-5 half-lives before elective surgery to allow adequate immune recovery and reduce perioperative infection risk; the half-life determines the appropriate washout period

Biologic half-lives vary significantly and determine the appropriate perioperative washout period: Infliximab (9-12 days — withhold 4-6 weeks), Adalimumab (14 days — withhold 4-6 weeks), Etanercept (3 days — withhold 2-3 weeks), Ustekinumab (15-46 days — withhold 12 weeks), Secukinumab (27 days — withhold 8 weeks), Risankizumab (28 days — withhold 12 weeks). The 3-5 half-life washout allows adequate immune reconstitution for wound healing and infection defence. Minor dermatological procedures under local anaesthesia generally do not require biologic interruption. The decision should be shared between dermatologist, surgeon, and anaesthetist.

Reference: BAD 2020 Biologic Guidelines; BSR Perioperative