Rheumatoid arthritis

A step closer to biomarker guided treatment decisions

UK researchers have made a positive step towards identifying blood biomarkers that could help predict response to anti-TNF treatment.

Researcher and presenter James Oliver from Arthritis Research UK Centre said while biologic therapy had revolutionised the treatment of rheumatoid arthritis up to 40 percent of patients do not respond adequately to medication.

“While we can’t predict which drug will work best for which patient treatment is a trial and error process which exposes patients to increased disability and drug toxicity,” he said.

“Ideally we would have a biomarker we could measure when patients are first diagnosed and then patients could be stratified and given the correct treatment in the first instance.”

Such a biomarker could come from measuring gene expression and checking whether this correlates with treatment response, he explained.

Gene expression biomarkers were already successfully being used to guide treatment in cancers, he noted.

In the current study the research team performed gene expression profiling on blood samples of 70 patients with RA who were participating in the Biologics in RA Genetics and Genomics Study Syndicate (BRAGGSS study).

At three months 50 of the patients had demonstrated a good response to adalimumab treatment and 20 patients who had shown no response to the anti-TNF.

When the research team evaluated the levels of gene expression in the blood samples they discovered a distinct change in the RA patients who had responded to treatment.

There were no significant differences in gene expression between baseline and three months in non-responders.

According to Oliver their finding of an immune signature in response to adalimumab had the potential to reduce the impact of long-term radiological damage and reduce spending on RA treatment.

However larger independent replication was required before the findings could be transferred into the clinic, he added.

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