Patients with rheumatoid arthritis may no longer have to deal with “trial-and-error” therapeutic approaches, thanks to precision medicine.
In January, experts told Healthline that precision medicine would be the next big thing in treatment for rheumatoid arthritis as well as cancer.
It turned out they were spot-on in their predictions, at least for rheumatoid arthritis (RA).
While targeted therapies for RA are nothing new, advances are constantly being made in precision treatments for managing this painful, complicated, and potentially dangerous autoimmune condition that affects 1.3 million Americans, many of whom are disabled by the ailment.
In 2016, researchers at Yale identified a genetic mechanism that may increase a person’s risk for rheumatoid arthritis. They concluded that the targeted use of precision medicine might help to single out and suppress that particular gene.
Because of this and other discoveries, RA researchers have been looking at gene variants, gene mutations, and other biological factors that could put some individuals —- but not others — at a higher risk for RA.
Now, scientists are bringing precision medicine even more to the forefront by using genetic profiling of joint tissues with the goal of figuring out which specific drugs will work for which individual RA patients.
This research is detailed in a new Northwestern Medicine study that will be published in the May issue of the Arthritis & Rheumatology journal.
Currently, patients and rheumatologists spend a lot of time and money going through the trial-and-error method of finding an RA drug that works.
Sometimes, these drugs are ineffective. Sometimes, they are dangerous. And, they are always costly.
Because of the inherent risks and the high price tag, it can be disappointing to people with RA and their doctors when a drug is ineffective, or, when a patient plateaus on it or has adverse reactions.
Researchers now hope to utilize precision medicine and genetic profiling to pinpoint which meds will work for which patients. They hope this will minimize this cycle of trying and failing on a multitude of pharmaceuticals before finding a drug that works for them.
“Now we can start to predict which drugs a patient will respond to,” said Harris Perlman, PhD, a co-senior author of the study and chief of rheumatology at Northwestern University Feinberg School of Medicine. “We can truly do precision medicine for rheumatoid arthritis. I believe this could be game changing.”
“We have so many different biologic drugs and there’s no rhyme or reason to give one drug versus the other,” Perlman added. “We waste $2.5 billion a year in ineffective therapy. And patients go through 12 weeks of therapy, don’t respond, and get upset.”
The scientists in this new multisite study are the first in the United States to employ a method using ultrasound technology to take and biopsy tissue from affected joints instead of using blood samples and imaging such as X-rays and MRIs.
“It’s just like oncology, where you go to the tumor,” Perlman told Healthline. “Why go anywhere else? In rheumatoid arthritis, we’ve never gone to the target organ.”
So now, they’re trying to use ultrasound-guided technology to do just that.
In the study, researchers at six sites analyzed tissue from 41 RA patients.
They separated different immune cell populations from patients, based on genes and microphages instead of just clinical presentation, labs, or demographic and lifestyle factors, as has been done in other studies and treatment approaches.
This study used genotyping. The patients were divided into shared genetic profiles to figure out which types of therapies were working for the patients in these genetic groups whose joints were responding well.
The researchers will then try to use this data to predict which patients, based on genetic profile, will have the best responses to which drugs.
It isn’t an exact science yet, but with precision medicine, it may someday be just that.
By taking biopsies of joint tissue at the beginning of a treatment as well as six weeks in, the researchers hope to find a predictive gene sequence that will clearly identify which patients respond to the therapy, and which patients — with which genetic profiles — do not.
“The idea is to develop gene sequences to predict whether a patient will respond or not,” Perlman said. “Our goal is that this procedure will become the standard of care for all patients with rheumatoid arthritis.”