Getting personal about skin: Realizing precision medicine in dermatology

Brownstone, Nicholas; Wu, Jashin J.; Strober, Bruce; Dickerson, Tobin J.

doi:10.1002/der2.99

Cited by 3 publications

(4 citation statements)

References 69 publications

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“…In the future, genetic predictors and biomarkers can also be incorporated into this system which will bring us closer to precision medicine in psoriasis. Precision medicine has the potential to further drastically change psoriasis management, improve outcomes, and even reduce costs [32]. We have encountered several hurdles of which the price of such a platform and the acceptability regarding data storage/accessibility within a hospital remain as the main obstacles.…”

Section: Discussionmentioning

confidence: 99%

PsoPlus: An Integrated Practice Unit for Psoriasis

et al. 2023

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There is a need to revise current healthcare organization due to the ever-rising costs and variation in quality of delivered care. Over the past decades there have been several strategic frameworks attempting to tackle this problem. Value-based healthcare (VBHC) is one those frameworks which has gained increasing popularity the last years. The framework is formulated on the premise that the healthcare sector should deliver integrated care, using integrated practice units (IPUs), and strive to maximize the value created. Value in this context is defined as the health outcomes achieved per costs made. We have designed a lean IPU called PsoPlus in which psoriasis patients are managed by a multidisciplinary team which has all the expertise and skill to manage psoriasis and its associated conditions. In addition, we have developed and implemented guidelines for the management of psoriasis associated comorbidities enabling us to deliver integrated care in the Belgian healthcare setting. Finally, we have designed a supporting information technology platform, called PsoSmart, that brings data from patients and healthcare providers together and provides actionable insights for clinical decision making. The created value is documented and captured using a value-based outcome set. Cost assessments at the individual patient level are also performed. To conclude, we describe here a comprehensive IPU setting for psoriasis which incorporates the VBHC principles. This IPU goes further and delivers a higher level of integrated care than other multidisciplinary psoriasis clinics. Monitoring outcomes and costs provides us with further insights to optimize psoriasis care. In addition, a software program designed to enhance psoriasis care is being developed further, however, advances in healthcare technology are needed.

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Section: Discussionmentioning

confidence: 99%

PsoPlus: An Integrated Practice Unit for Psoriasis

et al. 2023

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“…However, precision medication for dermatological diseases is yet to reach momentum. Advances in skin pathology and genetic profiles have revealed specific biomarkers in inflamed, wounded, and oncologic skin, opening up new pathways to explore personalized therapies for improved clinical outcome for patients suffering from skin diseases . By utilizing the versatility of biomaterials and different formulation approaches, it is possible to design improved targeting strategies and disease-controlled drug release .…”

Section: Introductionmentioning

confidence: 99%

“…Advances in skin pathology and genetic profiles have revealed specific biomarkers in inflamed, wounded, and oncologic skin, opening up new pathways to explore personalized therapies for improved clinical outcome for patients suffering from skin diseases. 4 By utilizing the versatility of biomaterials and different formulation approaches, it is possible to design improved targeting strategies and disease-controlled drug release. 5 For the latter, stimuli-responsive drug delivery systems are designed to "sense" the surrounding physiological environment and respond to a specific stimulus for on-demand release of encapsulated therapeutic cargos.…”

Section: Introductionmentioning

confidence: 99%

Protease-Responsive Hydrogel Microparticles for Intradermal Drug Delivery

et al. 2023

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Protease-responsive multi-arm polyethylene glycol-based microparticles with biscysteine peptide crosslinkers (CGPGG↓LAGGC) were obtained for intradermal drug delivery through inverse suspension photopolymerization. The average size of the spherical hydrated microparticles was ∼40 μm after crosslinking, making them attractive as a skin depot and suitable for intradermal injections, as they are readily dispensable through 27G needles. The effects of exposure to matrix metalloproteinase 9 (MMP-9) on the microparticles were evaluated by scanning electron microscopy and atomic force microscopy, demonstrating partial network destruction and decrease in elastic moduli. Given the recurring course of many skin diseases, the microparticles were exposed to MMP-9 in a flare-up mimicking fashion (multiple-time exposure), showing a significant increase in release of tofacitinib citrate (TC) from the MMP-responsive microparticles, which was not seen for the non-responsive microparticles (polyethylene glycol dithiol crosslinker). It was found that the degree of multi-arm complexity of the polyethylene glycol building blocks can be utilized to tune not only the release profile of TC but also the elastic moduli of the hydrogel microparticles, with Young’s moduli ranging from 14 to 140 kPa going from 4-arm to 8-arm MMP-responsive microparticles. Finally, cytotoxicity studies conducted with skin fibroblasts showed no reduction in metabolic activity after 24 h exposure to the microparticles. Overall, these findings demonstrate that protease-responsive microparticles exhibit the properties of interest for intradermal drug delivery.

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“…In recent years, dermatology research has seen an influx of molecular data that when combined with bioinformatic methods, makes the promise of precision medicine a reality. 1 Indeed, the need for precision medicine in the treatment of moderate-to-severe psoriasis patients was highlighted in the most recent AAD/NPF guidelines. 2 With the dramatic increase in spending on biologic drugs and an increasing array of biologic drugs available, physicians have been required to implement a trial-and-error paradigm to identify the best drug for a given patient.…”

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confidence: 99%

Interim Clinical Utility Findings of a Transcriptomic Psoriasis Biologic Test Demonstrate Altered Physician Prescribing Behavior and Improved Patient Outcomes

Strober

Bukhalo²,

Armstrong³

et al. 2022

J of Skin

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Objective: This study (MATCH) was designed to assess the clinical utility of a machine-learning based tool (Mind.Px) that predicts patient response to the most common biologic drug classes used in the management of psoriasis patients. Methods: The MATCH study was designed to assess Mind.Px utility in physician decision making and patient outcomes. Psoriasis patients who were biologic naïve or those who were approaching a change due to non-response were enrolled into the study (N=112). At baseline, a dermal biomarker patch was applied to lesional skin and Mind.Px test results were provided to physicians prior to biologic selection. The choice of biologic for each patient was recorded and in the case of physician non-concordance with Mind.Px test results, a questionnaire completed to determine the reason for non-concordance. Patients were evaluated at weeks 4, 8, 12, and 16 after baseline using PASI, PGA, and BSA. Statistical analysis between groups was performed using Fisher’s exact test. Results: Physician prescribing behavior was measured with and without the inclusion of Mind.Px test results in the decision-making process. This data set was compared to a previously obtained data set in which dermal biomarker patches were applied at baseline, but Mind.Px results were not provided to physicians at any point during treatment (N=180). Statistical analysis of concordance between the Mind.Px-informed and Mind.Px-uninformed groups within the MATCH study (84.4% vs 53.8%, respectively) showed that when given access to Mind.Px results, physician behavior was significantly altered (p = 0.0022). Furthermore, analysis of those patients who have completed the study showed improved clinical outcomes in those patients whose physicians were provided Mind.Px test results. Specifically, this cohort reached PASI75 sooner than those who were not provided test results (p = 0.004). Conclusion: These results provide an interim measurement of the clinical utility of Mind.Px by demonstrating that physicians will utilize this test in psoriasis biologic decision making and by doing so, this leads to improved patient outcomes. These improved patient outcomes can also potentially translate into tremendous cost savings for healthcare systems. Mind.Px can effectively minimize the trial-and-error approach to psoriasis treatment, and provide physicians, patients, and payers with a powerful tool for improving psoriasis patient management.

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Getting personal about skin: Realizing precision medicine in dermatology

Cited by 3 publications

References 69 publications

PsoPlus: An Integrated Practice Unit for Psoriasis

PsoPlus: An Integrated Practice Unit for Psoriasis

Protease-Responsive Hydrogel Microparticles for Intradermal Drug Delivery

Interim Clinical Utility Findings of a Transcriptomic Psoriasis Biologic Test Demonstrate Altered Physician Prescribing Behavior and Improved Patient Outcomes

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