From the Guidelines
The most effective approach to increase the efficacy of biologic therapy selection in rheumatoid arthritis patients is to use a combination of genetic testing, serological testing, and multi-biomarker disease activity tests, such as Vectra DA, in conjunction with clinical assessment and patient preferences. Several testing options are available to help guide biologic therapy selection, including:
- Genetic testing for HLA-DRB1 shared epitope alleles to identify patients more likely to respond to certain biologics, particularly TNF inhibitors 1
- Serological testing for rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) to predict response patterns, with seropositive patients generally responding better to rituximab 1
- Synovial biopsies to identify specific inflammatory patterns that may guide therapy selection
- Therapeutic drug monitoring to measure drug levels and anti-drug antibodies, allowing for dose optimization and early detection of treatment failure
- Metabolomic profiling to examine small molecules in blood and predict response to specific biologics
- Cytokine profiling to identify predominant inflammatory pathways and match patients to biologics targeting those specific pathways
- Multi-biomarker disease activity tests, such as Vectra DA, to assess overall disease activity and potentially predict treatment response 1
These testing approaches should be integrated with clinical assessment, patient preferences, and comorbidities to optimize biologic selection, as no single test is definitive for all patients. The European League Against Rheumatism (EULAR) recommends a treat-to-target approach, with the goal of achieving clinical remission, and provides guidance on the use of conventional synthetic DMARDs, glucocorticoids, biological DMARDs, and targeted synthetic DMARDs 1.
From the Research
Testing for Biologic Therapy Selection in Rheumatoid Arthritis
To increase the efficacy of biologic therapy selection in patients with rheumatoid arthritis (RA), several testing methods can be considered:
- Genetic testing to identify genetic markers associated with response to specific biologic therapies 2
- Biomarker testing to identify biomarkers associated with disease activity and response to treatment 3
- Pharmacogenetic testing to identify genetic variations that affect an individual's response to certain medications 4
- Patient preference testing to identify patient preferences for treatment characteristics such as route of administration and frequency of dosing 4
Novel Methods for Biologic Therapy Selection
Some novel methods that may not be standard of care yet but have shown promise in improving response to biologic therapy selection include:
- Personalized medicine approaches to identify primary non-responders to anti-TNF therapy 3
- Treatment strategies that prioritize tight control and treat-to-target approaches over specific drug selection 5
- Discrete-choice experiments to examine patient preferences for treatment characteristics 4
- Examination of patient characteristics and disease activity to inform treatment decisions 6
Importance of Treatment Strategies
Treatment strategies are more important than the specific biologic therapy selected, with tight control and treat-to-target approaches being key to achieving remission or low disease activity in RA patients 5. A personalized medicine approach that takes into account patient characteristics, disease activity, and treatment preferences may help improve response to biologic therapy selection 3, 4.