University of Louisville School of Medicine, Louisville, KY, USA.
Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Expert Opin Drug Metab Toxicol. 2024 Apr;20(4):249-262. doi: 10.1080/17425255.2024.2335310. Epub 2024 Mar 28.
Psoriasis is a chronic inflammatory immune condition. Treatments for psoriasis vary with disease severity, ranging from topicals to systemic biologic agents. The pharmacokinetic (PK) and pharmacodynamic (PD) properties of these therapies establish drug efficacy, toxicity, and optimal dosing to ensure therapeutic drug levels are sustained and adverse effects are minimized.
A literature search was performed on PubMed, Google Scholar, and Ovid MEDLINE for PK and PD, efficacy, and safety data regarding oral systemic nonbiologic therapies utilized for moderate-to-severe plaque psoriasis. The findings were organized into sections for each drug: oral acitretin, methotrexate, cyclosporine, apremilast, tofacitinib, and deucravacitinib.
Some psoriasis patients may not respond to initial therapy. Ongoing research is evaluating genetic polymorphisms that may predict an improved response to specific medications. However, financial and insurance barriers, as well as limited genetic polymorphisms correlated with treatment response, may restrict the implementation of genetic testing necessary to personalize treatments. How well psoriasis patients adhere to treatment may contribute greatly to variation in response. Therapeutic drug monitoring may help patients adhere to treatment, improve clinical response, and sustain disease control.
银屑病是一种慢性炎症性免疫疾病。银屑病的治疗方法因疾病严重程度而异，从局部治疗到全身生物制剂。这些治疗方法的药代动力学（PK）和药效学（PD）特性决定了药物的疗效、毒性和最佳剂量，以确保治疗药物水平的持续和不良反应的最小化。
在 PubMed、Google Scholar 和 Ovid MEDLINE 上进行了文献检索，以获取用于中重度斑块型银屑病的口服系统性非生物治疗的 PK 和 PD、疗效和安全性数据。研究结果按照每种药物的类别进行了组织：口服阿维 A、甲氨蝶呤、环孢素、阿普司特、托法替尼和德瓦鲁单抗。
一些银屑病患者可能对初始治疗没有反应。正在进行的研究评估了可能预测对特定药物更好反应的遗传多态性。然而，经济和保险障碍以及与治疗反应相关的有限遗传多态性可能限制了必要的个性化治疗的遗传检测的实施。银屑病患者对治疗的依从性在很大程度上可能导致反应的差异。治疗药物监测可能有助于患者坚持治疗、改善临床反应和维持疾病控制。
