Camela Elisa, Potestio Luca, Ruggiero Angelo, Ocampo-Garza Sonia Sofia, Fabbrocini Gabriella, Megna Matteo
Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Dermatology Department, Universidad Autónoma de Nuevo León, University Hospital ¨Dr. José Eleuterio González¨, Monterrey, Nuevo León, México.
Psoriasis (Auckl). 2022 Sep 1;12:231-250. doi: 10.2147/PTT.S328460. eCollection 2022.
Although innovative targeted therapies have positively revolutionized psoriasis treatment shifting treatment goals to complete or almost complete skin clearance, primary or secondary lack of efficacy is still possible. Hence, identifying robust biomarkers that reflect the various clinical psoriasis phenotypes would allow stratify patients in subgroups or endotypes, and tailor treatments according to the characteristics of each individual (precision medicine). To sum up the current progress in personalized medicine for psoriasis, we performed a review on the available evidence on biomarkers predictive of response to psoriasis treatments, with focus on phototherapy and systemic agents. Relevant literature published in English was searched for using the following databases from the last five years up to March 20, 2022: PubMed, Embase, Google Scholar, EBSCO, MEDLINE, and the Cochrane library. Currently, more evidence exists towards biologicals, as justified by the huge health care costs as compared to phototherapy or conventional systemic drugs. Among them, most of the studies focused on anti-TNF and IL12/23, with still few on IL17 (mainly secukinumab). The most discussed biomarker gene is the HLA-C*02:06 status that has been shown to be associated with psoriasis, and also differential response to biologicals. Although its positivity is associated with great response to MTX, debatable results were retrieved concerning both anti-TNF and IL12/23 while it seems not to affect secukinumab response. Personalized treatment in psoriasis would provide excellent outcome minimizing the risk of side effects. To date, although several candidates were proposed and assessed, the scarcity and heterogeneity of the results do not allow the identification of the gold-standard biomarker per each treatment. Anyway, the creation of a more comprehensive panel would be more reliable for the treatment decision process.
尽管创新的靶向疗法彻底改变了银屑病的治疗方式，将治疗目标转向完全或几乎完全清除皮肤病变，但原发性或继发性疗效不佳的情况仍有可能发生。因此，识别能够反映银屑病各种临床表型的可靠生物标志物，将有助于对患者进行亚组或内型分层，并根据个体特征量身定制治疗方案（精准医学）。为了总结银屑病个性化医疗的当前进展，我们对预测银屑病治疗反应的生物标志物的现有证据进行了综述，重点关注光疗和全身用药。使用以下数据库检索了截至2022年3月20日的过去五年中以英文发表的相关文献：PubMed、Embase、谷歌学术、EBSCO、MEDLINE和Cochrane图书馆。目前，与光疗或传统全身药物相比，生物制剂方面有更多的证据，这是由巨大的医疗保健成本所证明的。其中，大多数研究集中在抗TNF和IL12/23，而针对IL17的研究仍然很少（主要是司库奇尤单抗）。讨论最多的生物标志物基因是HLA-C*02:06状态，它已被证明与银屑病有关，并且对生物制剂有不同的反应。虽然其阳性与对甲氨蝶呤的良好反应相关，但关于抗TNF和IL12/23的结果存在争议，而它似乎不影响司库奇尤单抗的反应。银屑病的个性化治疗将提供出色的治疗效果，同时将副作用风险降至最低。迄今为止，尽管提出并评估了几种候选生物标志物，但结果的稀缺性和异质性使得无法确定每种治疗的金标准生物标志物。无论如何，创建一个更全面的生物标志物组合对于治疗决策过程将更可靠。
