Progress to Date in Advancing Stratified Medicine in Psoriasis
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LEADING ARTICLE
Progress to Date in Advancing Stratified Medicine in Psoriasis Claire Reid1,2 · Lis Cordingley3 · Richard B. Warren1,2 · Christopher E. M. Griffiths1,2
© Springer Nature Switzerland AG 2020
Abstract Stratified medicine is the tailoring of treatment to the individual characteristics of each patient. This is a challenging task in the context of psoriasis, a complex disease with a variety of phenotypic presentations and a comorbidity burden that extends beyond cutaneous manifestations. In recent years, considerable progress has been made in understanding the immunology of psoriasis, and this has informed the development of increasingly precise and efficacious therapies. However, not all patients respond to biologic therapy, and access is limited to patients with moderate to severe disease. However, subpopulations of patients are emerging with distinct patterns of response to therapy, largely determined by clinical and pharmacogenomic factors. Despite progress to date, the natural history of psoriasis remains poorly understood. It is likely that disease onset, progression, development of comorbidities and response to therapy are due to a combination of genetic, inflammatory and environmental factors. We envision that a greater understanding of the natural history of psoriasis will be a key factor in progressing a stratified medicine approach to patient care, as will earlier intervention in the course of the disease. Key Points Psoriasis is a complex, immune-mediated inflammatory skin disease dependent on environmental factors and genetic predisposition for expression, pathogenesis, progression and development of comorbidities. Research on stratification among patients with psoriasis will enhance our understanding of both the condition and the factors that may predict response to therapy. Progress in stratification of psoriasis is slow, but themes are emerging. However, patients with psoriasis have many unmet management needs that also need to be addressed.
* Claire Reid [email protected] 1
Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre University of Manchester, Manchester, UK
2
Dermatology Department, Salford Royal NHS Foundation Trust, Salford, UK
3
Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
1 Introduction Psoriasis is a complex immune-mediated inflammatory disease (IMID). Once believed to be confined to the skin, it is now recognised as a systemic disease associated with an increased lifetime risk of several comorbidities, including inflammatory arthritis [1], mood disorders [2] cardiovascular disease risk factors [3], Crohn’s disease and uveitis [4]. Stratified medicine is the tailoring of treatment to the individual characteristics of each patient. This typically involves identifying endotypes of either disease pathogenesis or drug response. This approach to care is well-established for cancer treatment and has revolutionised patient outcomes, th
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