Predicting therapeutic response through biomarker analysis in psoriatic arthritis, an example of precision medicine

Introduction: Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis for which effective targeted therapies are now available. However, despite such advances up to 40% of patients fail to meet the primary endpoint in clinical trials. Current approach to therapy does not take it account clinical or molecular heterogeneity and is based on trial-and-error. It is envisioned that choosing therapies based on appropriate molecular biomarker profiles will help choose the appropriate therapy for a patient and as such lead to better treatment outcomes with reduced costs and less exposure to less effective therapies.Areas covered: The paper introduces PsA and briefly describes the clinical phenotype, pathogenesis, and current therapies. Current literature on biomarkers relating to PsA treatment response is reviewed. Limitations of the current approach, potential solutions to issues identified, and a path forward for research and potential clinical application in this area are discussed.Expert opinion: The likelihood that the current siloed approach to biomarker discovery will lead to meaningful clinically actionable tests to facilitate precision medicine in PsA is low. We envision that with collaborative and harmonized effort by all stakeholders using an inter-omic approach will lead to the development of robust predictive biomarkers for PsA treatment response.