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Extended reports
HLA-DRB1 typing in rheumatoid arthritis: predicting response to specific treatments
  1. James R O’Della,b,
  2. Barbara S Nepomd,
  3. Claire Hairea,
  4. Vivian H Gersukd,
  5. Lakshmi Gaurd,
  6. Gerald F Moorea,
  7. Walter Drymalskic,
  8. William Palmerc,
  9. P James Eckhoffc,
  10. Lynell W Klassena,b,
  11. Steven Weesc,
  12. Geoffrey Thiele,
  13. Gerald T Nepomd
  1. aDepartment of Internal Medicine, University of Nebraska Medical Center (UNMC), USA, bOmaha Veterans Affairs Medical Center, USA, cAffiliated Rheumatoid Arthritis Investigational Network (RAIN) clinics, USA, dVirginia Mason Research Center (VMRC), Seattle, WA, USA
  1. Dr J R O’Dell, University of Nebraska Medical Center, Department of Internal Medicine, 600 South 42nd Street, Omaha, Nebraska 68198–3025, USA.

Abstract

OBJECTIVE To determine the predictive value of shared epitope alleles for response to treatment in patients with rheumatoid arthritis.

METHODS Patients 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.

RESULTS Shared 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).

CONCLUSIONS These data suggest that determining shared epitope status may provide clinical information useful in selecting among treatment options.

  • DRB1
  • rheumatoid arthritis
  • combination treatment
  • shared epitope

https://doi.org/10.1136/ard.57.4.209

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