Precision Medicine for Rheumatoid Arthritis: The Right Drug for the Right Patient—Companion Diagnostics

Abstract

Despite the growing number of biologic and JAK inhibitor therapeutic agents available to treat various systemic autoimmune illnesses, the lack of a validated companion diagnostic (CDx) to accurately predict drug responsiveness for an individual results in many patients being treated for years with expensive, ineffective, or toxic drugs. This review will focus primarily on rheumatoid arthritis (RA) therapeutics where the need is greatest due to poor patient outcomes if the optimum drug is delayed. We will review current FDA-approved biologic and small molecule drugs and why RA patients switch these medications. We will discuss the sampling of various tissues for potential CDx and review early results from studies investigating drug responsiveness utilizing advanced technologies including; multiplex testing of cytokines and proteins, autoantibody profiling, genomic analysis, proteomics, miRNA analysis, and metabolomics. By using these new technologies for CDx the goal is to improve RA patient outcomes and achieve similar successes like those seen in oncology using precision medicine guided therapeutics.

Levelling the playing field of RMD research across Europe to address patients’ needs: the emerging EULAR Research Centre

“…While biological agents have improved the treatment of RMDs such as rheumatoid arthritis (RA), health outcomes in patients with RA are still poorer than in the general population. It remains difficult to predict which drug will be effective for a given patient 24. To overcome the challenges of current, ‘lottery-like’ 25 therapeutic approaches, there is a need for novel biomarkers tailored to patients’ expected therapeutic responsiveness.…”

“…It remains difficult to predict which drug will be effective for a given patient. 24 To overcome the challenges of current, ‘lottery-like’ 25 therapeutic approaches, there is a need for novel biomarkers tailored to patients’ expected therapeutic responsiveness. Synovial tissue research, for example, has become widely developed, but large discrepancies exist in the way synovial tissue is handled, and how data pertaining to biopsy procedure, quality check and experimental results are reported in the literature.…”

Mucosa‐associated lymphoid tissue lymphoma translocation protein 1 in rheumatoid arthritis: Longitudinal change after treatment and correlation with treatment efficacy of tumor necrosis factor inhibitors

“… 3 Fortunately, with the induction of tumor necrosis factor (TNF) inhibitors, the most commonly used biologics, the treatment approaches of RA have been greatly enriched. 4 , 5 , 6 For RA patients who may not respond to conventional disease‐modifying anti‐rheumatoid drugs (cDMARDs), using TNF inhibitors is a promising option; meanwhile, it is also reported that using TNF inhibitors as the first‐line therapy is a cost‐effective strategy. 7 , 8 , 9 However, there are still some patients who may not response to TNF inhibitors.…”

Effectiveness and Safety of Iguratimod Monotherapy or Combined With Methotrexate in Treating Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

“…Rheumatoid arthritis (RA) is an autoimmune disease that alternates between progressing and stabilizing owing to abnormal immune response. The disease's etiology is still unknown, and the pathogenesis is complicated (Meehan et al, 2021). The primary pathological foundation is erosive synovitis, which gradually leads to angiogenesis and pannus formation (Matsui et al, 2009), and finally leads to joint bone and cartilage destruction, resulting in joint deformity and dysfunction (Auréal et al, 2020).…”