Would Vectra (Multi-Biomarker Disease Activity) testing be helpful?

From the Guidelines

Vectra testing can be a valuable tool in assessing disease activity in patients with rheumatoid arthritis (RA), particularly when clinical evaluation is unclear or when patients have comorbidities that may confound symptom interpretation, as supported by the FDA-approved multibiomarker disease activity panel (MBDA) marketed as VectraDA 1.

Key Points to Consider

• Vectra testing measures 12 biomarkers in peripheral blood to provide a single numerical value indicating disease activity, which can help guide treatment decisions.
• The test is most useful for monitoring disease progression and treatment response, especially when considering changes to therapy.
• Vectra testing should complement, not replace, clinical evaluation and other laboratory tests like CRP or ESR.
• The decision to use Vectra testing should be made in consultation with a rheumatologist, taking into account individual clinical circumstances and treatment goals.

Evidence-Based Recommendations

• According to the American College of Rheumatology, standardized assessment of disease activity in RA facilitates treating to target, which has been shown to improve disease outcomes 2.
• The use of validated RA disease activity measures, such as VectraDA, can help clinicians demonstrate high-quality care for RA patients and provide necessary tools for treating to target.
• However, it is essential to note that Vectra testing may not be necessary for all RA patients, and its use should be determined on a case-by-case basis, considering factors like insurance coverage and individual patient needs.

Clinical Application

• In clinical practice, Vectra testing can be particularly valuable for patients with unclear disease activity or those who have not responded to initial treatments.
• By providing a more accurate assessment of disease activity, Vectra testing can help clinicians make informed decisions about treatment adjustments, ultimately improving patient outcomes and quality of life.

From the Research

Vectra Testing for Rheumatoid Arthritis

• Vectra DA is a blood test that provides an objective measure of disease activity in patients with rheumatoid arthritis (RA) 3.
• The test measures the concentrations of 12 biomarkers that reflect the pathophysiologic diversity of RA, providing an accurate and reproducible score on a scale of 1 to 100 3.
• Vectra DA scores have been shown to correlate with imaging of joint inflammation and are predictive of radiographic progression, with high scores associated with more frequent and severe progression 3.

Clinical Utility of Vectra Testing

• The Vectra DA test can help monitor therapeutic response to methotrexate and biologic agents, and assess clinically challenging situations such as non-inflammatory pain from fibromyalgia 3.
• However, a study found that the MBDA score did not reflect clinical disease activity in patients enrolled in the AMPLE trial, and should not be used to guide decision-making in the management of RA, particularly for patients who receive abatacept or adalimumab as the first biologic agent 4.
• The development of a multi-biomarker disease activity test for RA has been described, which uses 12 biomarkers to generate a score between 1 and 100, and has been shown to be associated with clinical disease activity levels 5.

Limitations of Laboratory Tests

• Laboratory tests, including Vectra DA, have limitations in diagnosing and managing RA, and cannot serve as a gold standard for diagnosis and management in all individual patients with RA 6.
• More than 30% of patients with RA have negative tests for rheumatoid factor or anti-CCP antibodies, and 40% have a normal ESR or CRP, highlighting the need for a comprehensive approach to diagnosis and management 6.
• The assessment of disease activity in RA is complex and requires a combination of clinical measures, laboratory tests, and patient-reported outcomes 7.