Predictive Factors of Response to Biological Disease Modifying Antirheumatic Drugs: Towards Personalized Medicine

Abstract

Many therapies are now available for patients with rheumatoid arthritis (RA) who have an inadequate response to methotrexate including tumor necrosis factor inhibitors, abatacept, tocilizumab, and rituximab. Clinical response to drugs varies widely between individuals. A part of this variability is due to the characteristics of the patient such as age, gender, concomitant therapies, body mass index, or smoking status. Clinical response also depends on disease characteristics including disease activity and severity and presence of autoantibodies. Genetic background, cytokine levels, and immune cell phenotypes could also influence biological therapy response. This review summarizes the impact of all those parameters on response to biological therapies.

A gender-medicine post hoc analysis (MetaGeM) project to test sex differences in previous observational studies in different diseases: methodology

“…[33][34][35] Sex-specific medicine is crucial to understand how different therapeutic needs are in men and women, and consequently to define potential different therapeutic approaches between males and females. 36 Clinical research sponsored by Novartis Farma Italy in the last decade has included several large observational studies in important medical areas, such as dermatology, 15,16,18,19 rheumatology, 17 the CNS, [22][23][24][25] and infectious diseases, 37 but none of those studies, except the aforementioned GENDER ATTENTION study, adopted a sex-specific approach in data analysis. Based on the increasing interest in gender-medicine and moved by the great amount of clinical data available through those large national studies, we decided to reanalyze these data from a gender perspective.…”

Managing patients with rheumatoid arthritis

“…7 Smoking reduces the efficacy of conventional DMARDs and smokers are more likely to fail on biologic therapies. 24 In RA, the pain response appears to be heightened; analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) can be used for additional symptom control. 7,25 Due to unfavourable side-effects, corticosteroid use is restricted to bridging therapy during acute flares of symptoms ('flare-ups') whilst awaiting DMARDs to reach full efficacy.…”

Hogyan ellenőrzi az immunrendszer a daganatok kialakulásának és növekedésének folyamatát?

“…A gyulladásos reumatológiai kórképek kezelése során gyakran nézünk szembe másodlagos hatástalanság-gal, amely egy sokszor hosszabb, hatásos időszak után következik be. Ez a biológiai kezelések alkalmazásakor gyakran előfordul és a nem kívánt hatások mellett a tartós gyógyszeradás egyik legnagyobb korlátja [20,21]. A jelenség hátterében sokszor gyógyszerellenes antitestképződés áll [21][22][23].…”

“…Ez a biológiai kezelések alkalmazásakor gyakran előfordul és a nem kívánt hatások mellett a tartós gyógyszeradás egyik legnagyobb korlátja [20,21]. A jelenség hátterében sokszor gyógyszerellenes antitestképződés áll [21][22][23]. Azonban a gyógyszer elvesztheti hatásosságát úgy is, hogy gyógyszerellenes antitest nem alakul ki.…”