Even the best therapies do not work if given to the wrong patient. In practice we assess the activity or severity of the disease using history, physical examination and various additional tests when making a decision as to which therapy to recommend. Such tests can be called biomarkers.
For many decades, there were only a few therapeutic agents in rheumatology and the choices among them were mostly based on “hit-or-miss”. As more and more effective therapies have been developed these choices are becoming more difficult and at the same time more critical, considering the impact that failure to control disease has on patient quality-of-life and long-term prognosis. But while therapy has become more sophisticated, our assessment tools have not kept pace: diagnostics rely on some biomarkers (RF, ACPA) and activity assessment on others (ESR, CRP) but clinical assessments and trial-and-error continue to play a major role.
The advent of next-generation biomarkers and biomarker panels are going to enable clinicians to become much more proactive and evidence-based in their daily practice. Data from recently published and ongoing studies show that biomarkers and biomarker panels help identify patients likely to respond to first-line or second-line therapy, patients at risk for radiographic progression, and patients more or less likely to respond to various biologics. Thus, the presence in serum of survivin, a tumor-associated cytokine found in around 1/3rd of patients with RA, was associated with poor response to MTX1. The multi-biomarker disease activity (MBDA) panel identified patients at risk for radiographic progression2, and was also shown to identify which patients could benefit more from triple therapy and which ones from anti-TNF3. And a low interferon-α signature in RA associated with higher likelihood to respond to rituximab4.
As rheumatology specialists, we must embrace these development in order to be able to provide our patients with the best possible treatment at cost levels that are sustainable for societies. Biomarkers are an indispensable part of our future.
1Levitsky A, Erlandsson MC, van Vollenhoven RF, Bokarewa MI. Serum survivin predicts responses to treatment in active rheumatoid arthritis: a post hoc analysis from the SWEFOT trial. BMC Med. 2015 Sep 30;13:247
2Hambardzumyan K, Bolce R, Saevarsdottir S, Cruickshank SE, Sasso EH, Chernoff D, Forslind K, Petersson IF, Geborek P, van Vollenhoven RF. Pretreatment multi-biomarker disease activity score and radiographic progression in early RA: results from the SWEFOT trial. Ann Rheum Dis. 2015 Jun;74(6):1102–9
3Hambardzumyan K et al. Submitted.
4Thurlings RM, Boumans M, Tekstra J, van Roon JA, Vos K, van Westing DM, van Baarsen LG, Bos C, Kirou KA, Gerlag DM, Crow MK, Bijlsma JW, Verweij CL, Tak PP. Relationship between the type I interferon signature and the response to rituximab in rheumatoid arthritis patients. Arthritis Rheum. 2010;62:3607–14.
Disclosure of Interest R. Van Vollenhoven Grant/research support from: AbbVie, Amgen, BMS, GSK, Pfizer, Roche, UCB, Consultant for: AbbVie, Biotest, BMS, Celgene, Crescendo, GSK, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, UCB, Vertex
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