A wide perspective of targeted therapies for precision medicine in autoimmune diseases

ABSTRACT

Introduction

The strategy of precision medicine is achieved by the stratification of patients and targeted therapy. It has been shown that the pathological conditions of patients who are classified or diagnosed with a single disease are actually diverse in almost all autoimmune diseases. Therefore, the practice of precision medicine is important for the treatment of patients with autoimmune diseases.

Areas covered

At present, precision medicine has not been achieved in any autoimmune disease. This article reviewed the attempted use of precision medicine for the treatment of systemic lupus erythematosus and psoriatic arthritis.

Expert opinion

Although multiple molecular-targeted therapies are available for the treatment of rheumatoid arthritis, the response to each treatment strategy often differs markedly among patients, and it is unclear how they are differentially selected for each patient. The establishment of precision medicine is especially important in heterogenous autoimmune diseases (e.g., systemic lupus erythematosus, psoriatic arthritis). Various symptoms must be improved at the same time, but the treatment options are limited. Therefore, the selection of the optimal treatment for individual patients is complex. Although some predictors of the treatment response are reported, precision medicine has not been sufficiently well evaluated in real clinical practice, especially for autoimmune diseases.

KEYWORDS:

• Autoimmune disease
• precision medicine
• psoriatic arthritis
• systemic lupus erythematosus
• treatment

Article highlights

• Stratification of patients is a strategy used in precision medicine to improve outcomes.

• Precision medicine is achieved by both stratification of patients and the establishment of targeted therapy. As the pathogenesis of patients with lupus is more heterogeneous than that of patients with other autoimmune diseases, precision medicine is urgently required for the treatment of systemic lupus erythematosus. Progress in clinical and basic research is desired.

• Several predictors of treatment response in psoriatic arthritis have been reported. However, there is insufficient evidence for precision medicine in actual clinical practice. Recently, the potential of precision medicine using biologics for the treatment of psoriatic arthritis has been suggested based on the results of peripheral blood lymphocyte analysis.

• The establishment of precision medicine is considered especially important in heterogenous autoimmune diseases (e.g., systemic lupus erythematosus, psoriatic arthritis). In these diseases, all the various symptoms need to be improved at the same time, but treatment options are limited. Therefore, the selection of optimal targeted therapies for individual patients may be more important and more difficult. Although some predictors of the treatment response have been reported, precision medicine has not been sufficiently well evaluated in real clinical practice. We aimed to elucidate the use of precision medicine in autoimmune diseases.

Declaration of interest

Y. Tanaka has received speaking fees and/or honoraria from Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, Janssen and has received research grants from Mitsubishi-Tanabe, Chugai, Abbvie, Takeda, UCB, Daiichi-Sankyo, Eisai. S. Kubo has no conflict of interest. I. Miyagawa has no conflict of interest. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.