Use of pharmacogenomics in psoriasis

Author(s): Caitriona Ryan, Anne Bowcock, Alan Menter

Patients with moderate-to-severe psoriasis frequently require treatment with systemic or biologic therapies, but considerable interpatient variability is observed in both clinical responsiveness and toxicity relating to these agents. Thus, identifying patients with a greater risk of treatment toxicity or nonresponse prior to treatment initiation would allow targeting of therapies more precisely and safely to individual patients and minimize unnecessary expenditure. The discovery of predictive markers of treatment response would be a useful tool in the development of individually tailored treatment. The role of pharmacogenomics is becoming increasingly important as healthcare moves towards the ultimate goal of personalized medicine. This article reviews the pharmacogenomics of psoriasis treatments to date and explores the potential of this growing research field to provide safer, more effective psoriasis treatment. In particular, we describe pharmacogenomic studies of methotrexate, cyclosporine, TNF-a inhibitors, efalizumab, alefacept and narrowband-UVB phototherapy. As psoriasis is a complex polygenic disorder with environmental and clinical influences at play, the combination of both molecular and clinical profiling is necessary to achieve optimal personalized management. To this end, we propose the development of models to predict treatment response by combining pharmacogenomic approaches with comprehensive clinical characterization.