Rheumatology Practice Changers 2014

Bret S. Stetka, MD; Stephen A. Paget, MD

Disclosures

December 18, 2014

In This Article

Bring On the Biomarkers

As in many fields of medicine, researchers are looking for biomarkers that might aid in the diagnosis and management of rheumatologic disease. And progress is being made.

In a study published earlier this year, Dennis and colleagues[5] reported on pretreatment gene expression profiles and protein patterns in synovial tissue that are associated with positive or negative clinical outcomes in response to treatment with adalimumab or tocilizumab for RA. Specifically, they identified two tissue-type–related blood-based protein biomarkers that could potentially be used to personalize therapy.

Another study,[6] done in Sweden, assessed the possibility of using the multibiomarker disease activity index (MBDA) to predict structural progression in patients with RA. The MBDA comprises 12 serum biomarkers that are collectively analyzed to determine a score; a score > 44 indicated high disease activity.

In this study, patients with RA of less than 1 year's duration who had not previously been treated with disease-modifying antirheumatic drugs (DMARDs), and who had moderate or high disease activity, as determined by Disease Activity Score-28 C-reactive-protein (DAS28 CRP), were treated with methotrexate (20 mg/wk) for 3 to 4 months. At 3 months, those with continued moderate to high disease activity were randomly assigned to receive either nonbiologic or biologic therapy.

The nonbiologic regimen initially consisted of methotrexate, sulfasalazine, and hydroxychloroquine triple therapy, which could be switched to cyclosporine A if patients did not respond. The biologic group initially received methotrexate and infliximab, the latter of which could be advanced to etanercept if there was inadequate response at 12 months.

The MBDA was found to better predict radiographic and clinical progression at 1 year than the DAS28, CRP level, or erythrocyte sedimentation rate (ESR) alone; the DAS-28 ESR; or the DAS-28 CRP. Moreover, 39% of patients treated with biologic therapy had a good response at 1 year, compared with only 25% on the nonbiologic regimen. These findings may help clinicians identify patients at low risk for progression who would probably do well on cheaper, nonbiologic therapies.

A study[7] published in the Annals of the Rheumatic Diseases in September reported the potential utility of biomarkers in psoriatic arthritis (PsA). A biomarker panel of 57 synovial tissue proteins reportedly helped predict treatment response to tumor necrosis factor (TNF)-alpha inhibitors or T-cell inhibitors. The authors wrote, "This panel may help to identify patients that will likely benefit from treatment including TNF-alpha inhibition and T-cell modulation, help monitor treatment and support the design of personalized treatment for patients."

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