Ann Rheum Dis 1998;57:209-213 ( April )

Extended reports

HLA-DRB1 typing in rheumatoid arthritis: predicting response to specific treatments James R O'Dell,^{a b} Barbara S Nepom,^d Claire Haire,^a Vivian H Gersuk,^d Lakshmi Gaur,^d Gerald F Moore,^a Walter Drymalski,^c William Palmer,^c P James Eckhoff,^c Lynell W Klassen,^{a b} Steven Wees,^c Geoffrey Thiele, Gerald T Nepom^d

^a Department of Internal Medicine, University of Nebraska Medical Center (UNMC), USA, ^b Omaha Veterans Affairs Medical Center, USA, ^c Affiliated Rheumatoid Arthritis Investigational Network (RAIN) clinics, USA, ^d Virginia Mason Research Center (VMRC), Seattle, WA, USA

Correspondence to: Dr J R O'Dell, University of Nebraska Medical Center, Department of Internal Medicine, 600 South 42nd Street, Omaha, Nebraska 68198-3025, USA.

Accepted for publication 4 March 1998

OBJECTIVETo determine the predictive value of shared epitope alleles for response to treatment in patients with rheumatoid arthritis.
METHODSPatients from our previously published triple DMARD study were tested for the presence of shared epitope alleles (DRB1 *0401,0404/0408, 0405,0101, 1001,and 1402). Patients who were shared epitope positive were then compared with those who were negative to see if there was a differential effect on therapeutic response.
RESULTSShared epitope positive patients were much more likely to achieve a 50% response if treated with methotrexate-sulphasalazine-hydroxychloroquine compared with methotrexate alone (94% responders versus 32%, p<0.0001). In contrast shared epitope negative patients did equally well regardless of treatment (88% responders for methotrexate-sulphasalazine-hydroxychloroquine versus 83% for methotrexate). Additionally, a trend toward an inverse relation of the gene dose was seen for response to methotrexate treatment (p=0.05).
CONCLUSIONSThese data suggest that determining shared epitope status may provide clinical information useful in selecting among treatment options.

Keywords: DRB1; rheumatoid arthritis; combination treatment; shared epitope

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© 1998 by Annals of the Rheumatic Diseases
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