Predicting the Unpredictable in Psoriasis Treatment

Abstract

Psoriasis is an autoimmune skin inflammation disease that causes silvery and erythematous scaly plaques. Moderate to severe psoriasis is treated using biologics to antagonize inflammatory cytokines and inhibit inflammatory responses in the skin and joints. However, primary treatment of psoriasis as administered in accordance with treatment guidelines fails for some patients. In these cases, the physician will attempt treatment with another biologic. However, changing treatments has adverse consequences such as physical and psychological burdens on patients as well as wasted health care resources. Even after treatment changes, however, the new biologic may be ineffective. Our goal was to investigate methods of selecting the most effective biologics for different patients with psoriasis. We created an innovative platform by using streptococcus induction and patients’ peripheral blood mononuclear cells to screen biologics, including anti-TNF-α, anti-IL-12/23, anti-IL-17, and anti-IL-23 biologics, for their effectiveness as measured by cytokine and chemokine expression. IL-4, IL-13 and interferon-r (IFN-r) were crucial markers for biologic efficacy in different individuals. By using this platform to prescreen the effectiveness of biologics on individual patients, physicians can devise evidence-based treatment plans, improving patient outcomes. The three benefits of using this platform to inform treatment plans are improved patient outcomes, reduced risk for doctors, and reduced economic burden on the health care system. The model and strategy for selecting biologics for psoriasis treatment proposed in this study enables precise treatment of individuals. Funding Statement: Research/Educational Grants from Taiwan (CMRC-CENTER-0) and Ministry of Science and Technology in Taiwan (MOST 109-2320-B-39-044). Declaration of Interests: All authors have completed the International Committee of Medical Journal Editors uniform disclosure form available at www.icmje.org/coi_disclosure.pdf , and declare that Dr. Hsieh and Dr. Yu have no conflicts of interest to declare. Dr. Yen participated as a speaker for AbbVie, Novartis Pharmaceuticals Corporation, Eli-Lilly, Janssen-Cilag Pharmaceutical, Leo Pharma and Sanofi Pfizer Limited. Dr. Lai participated as speaker for AbbVie, Novartis, Eli-Lilly and Janssen- Cilag Pharmaceuticals Corporations Dr. Yen has a pending patent on markers IFN-r, IFN-r/IL13, and IFN-r/IL4. Ethics Approval Statement: All participants provided written informed consent, and the study protocol was approved by the Institutional Review Board of Taichung Veterans General Hospital (TCVGH-CE16265B).