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With new research, medical professionals are even closer to implementing personalized medicine in care for patients with psoriatic arthritis.
Personalized medicine aims to develop and determine the ideal drug or intervention for the individual patient. Prof. Ennio Lubrano PhD, from the Department of Medicine and Health Sciences, University of Molise, in Italy, reviewed the evolution of personalized medicine and the use of biomarkers for patients with psoriatic arthritis.
Biomarkers are anatomical, serological, or physiological characteristics that can be measured objectively and can be indicators of normal or pathological disease processes and treatment interventions. Biomarkers should be assessed for diagnosis, disease activity, prognosis, response to treatment as well as comorbidities. Although some studies assessed biomarkers such as Class I HLA, microRNA, serum proteins and cytokines, “no arthritis-related biomarkers have been submitted to the FDA or EMA,” said Prof. Lubrano.
Currently, psoriatic disease treatment is seeing a shift towards personalised medicine. Based on initial data on clinical response and the immunophenotype characterized by activated Th1 and Th17 cells, a treatment algorithm was proposed in 2018. According to this algorithm, patients with dominant Th17 should receive secukinumab, patients with high Th1/Th17 with major joint involvement should receive TNF inhibition, patients with high Th1/Th17 with major skin involvement should receive secukinumab, patients with Th1/Th17 low should receive TNF inhibition, and the Th1 dominant group should receive ustekinumab. This treatment algorithm was more recently expanded with cell assessment based on peripheral immune cells, and updated from secukinumab to IL-17 inhibitors in general and ustekinumab to IL-12/23(p40) inhibitors in general.
Metabolomics analyses were also used to determine potential biomarkers that can predict progression from psoriasis to psoriatic arthritis. The cross-sectional longitudinal registry IPART enrolled participants with psoriasis or psoriatic arthritis and healthy controls. The 71 participants included 16 healthy controls, 21 psoriasis non-progressors, 13 psoriatic arthritis progressors, and 21 participants with psoriatic arthritis (total). The analysis showed that participants with psoriatic arthritis had significantly lower serum levels of bile acids (i.e. glycoursodeoxycholic acid sulfate, glycodeoxycholate 3-sulfate, and deoxycholic acid 12-sulfate; P<0.001) as well as significantly higher levels of purine metabolites (P<0.01). Furthermore, when assessing psoriasis non-progressors and psoriatic arthritic progressors, multiple regression analyses found leukotriene B4 and glycoursodeoxycholic acid sulfate as significant predictors of progression. These results suggest that gut dysbiosis and altered hepatic metabolism could be causal factors for progression in immune cell proliferation and change in cytokine profile.
“Precision medicine has not been sufficiently investigated in a real-world clinical setting (for psoriatic disease),” said Prof. Lubrano. However, “the dawn of precision medicine is emerging.” Precision medicine is “not yet useful for single patients but data are coming from different clusters for determining biomarkers.”
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