Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre University of Manchester, Manchester, UK.
Dermatology Department, Salford Royal NHS Foundation Trust, Salford, UK.
Am J Clin Dermatol. 2020 Oct;21(5):619-626. doi: 10.1007/s40257-020-00533-z.
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.
分层医学是根据每个患者的个体特征来定制治疗方案。在银屑病的背景下，这是一项具有挑战性的任务，因为银屑病是一种复杂的疾病，具有多种表型表现，且其合并症负担超出了皮肤表现。近年来，人们对银屑病的免疫学有了相当多的了解，这为开发越来越精确和有效的治疗方法提供了信息。然而，并非所有患者对生物治疗都有反应，而且这种治疗方法仅限于中重度疾病患者。然而，越来越多的患者亚群表现出对治疗的不同反应模式，这主要取决于临床和药物基因组学因素。尽管取得了迄今为止的进展，但银屑病的自然病史仍知之甚少。疾病的发生、进展、合并症的发展以及对治疗的反应可能是由遗传、炎症和环境因素共同作用的结果。我们设想，对银屑病自然病史的进一步了解将是推进分层医学患者护理方法的关键因素，而在疾病过程中更早地进行干预也将是一个关键因素。
