Pharmacogenomics: getting closer to a tailored therapy?

For each individual, pharmacogenomics searches for the correlations between genetic expression or the individual nucleotide polymorphism and the efficacy or toxicity of a drug. The purpose is to predict, for a genetically unique patient and a given disease, the efficacy and toxicity of drugs or their association so as to establish an individualized prescription bringing together a maximum of efficacy and tolerance. The value of pharmacogenomics in psoriasis is related to the presence of different clinical forms of psoriasis that do not respond to the same treatments, but also to the presence of patients who respond or do not respond to the same treatment for the same clinical form. The variable toxicity of the anti-psoriasis drugs depending on the individual is also a promising domain of application for pharmacogenomics. The existing pharmacogenomics data for the treatments currently in use (retinoids, vitamin D, methotrexate, cyclosporine, biotherapies) in psoriasis management are reviewed. The more specific data related to the HLA-Cw6 gene and efalizumab have shown that the response to efalizumab was not only greater, but also faster in HLA-Cw6+ patients. The HLA-Cw6 allel could also predict tolerance to efalizumab treatment, but this hypothesis needs to be confirmed. (C) 2008 Elsevier Masson SAS. Tous droits reserves.