The Role of Pharmacogenetics in Chronic Plaque Psoriasis: Update of the Literature
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REVIEW ARTICLE
The Role of Pharmacogenetics in Chronic Plaque Psoriasis: Update of the Literature Marina Talamonti1
•
Simone D’Adamio1 • Luca Bianchi1 • Marco Galluzzo1
Ó Springer International Publishing Switzerland 2017
Abstract Psoriasis is a chronic inflammatory disease triggered by both genetic and environmental factors. Systemic and biologic therapies used to treat moderate-tosevere psoriasis show significant variability in efficacy, are associated with various degrees of toxicity, and, for biologic therapies, are expensive. There is a great need for non-invasive biomarkers to predict treatment outcomes of these therapies and to individualize care for patients with psoriasis. This article reviews currently recognized pharmacogenetic targets related to the treatment of chronic plaque psoriasis, in particular to biologic therapies. The use of pharmacogenetic and pharmacogenomic approaches to genetically profile patients will allow therapies to be targeted more precisely and safely to individual patients, to optimize the treatment of psoriasis, and minimize unnecessary costs. Characterizing patients with psoriasis according to common molecular mechanisms rather than by clinical phenotype may also allow more selective therapeutic agents to be targeted to genetically distinct groups of patients.
& Marina Talamonti [email protected] 1
Department of Dermatology, University of Rome Tor Vergata, Viale Oxford, 81-00133 Rome, Italy
Key Points In the past two decades, advances in the knowledge of psoriasis pathogenesis have led to the identification of new therapeutic targets and the development of biological drugs. Nevertheless, severe psoriasis can still be extremely difficult to treat in some patients. The consideration of an individual’s pharmacogenetic profile could, in the future, be used not only to predict the response to therapy in psoriatic patients, but also to improve resource allocation and reduce patient exposure to unnecessary toxicity.
1 Introduction Psoriasis is a chronic inflammatory disease of the skin affecting approximately 2–3% of the population worldwide [1, 2]. It is characterized by epidermal hyperproliferation, abnormal keratinocyte differentiation, angiogenesis with blood vessel dilatation, and excess T-helper cell type 1 (Th1) and type 17 (Th17) inflammation [3]. Plaque type is the most common form of psoriasis affecting 85–90% of psoriatic patients [1]. Moreover, depending on the population studied, in 5–42% of patients, psoriatic arthritis may occur [4]. In most patients (70%), psoriasis is present for several years before the onset of arthritis. In 10–15% of patients, arthritis precedes psoriasis, and in the remaining 15% of patients, the initial presentation includes arthritis and psoriasis together [5, 6]. Other psoriasis phenotypes include guttate, palmoplantar pustulosis, and erythrodermic psoriasis.
M. Talamonti et al.
Psoriasis has a major functional and psychosocial impact on the everyday quality of life of sufferers, and satisfactory therapeutic approaches are t
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