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Reply to: Forget personalized medicine and focus on abating disease activity
  1. William Samuel Wilke
  1. Correspondence to Dr William S Wilke, Rheumatology Department, Cleveland Clinic Orthopedic and Rheumatology Institute (retired), Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A50, Cleveland, OH 44095, USA; wswilkemd{at}gmail.com, wswilkemd{at}yahoo.com

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The viewpoint ‘Forget personalised medicine and focus on abating disease activity’1 contends that similar clinical outcomes and converging mechanisms of action observed with biologic therapies make irrelevant use of biomarkers to personalise the use of targeted therapies in rheumatoid arthritis (RA). The authors posit that treatment responses to the second and third anti-tumour necrosis factor (TNF) agent or a change to another biologic agent in randomised, placebo-controlled trials (RPCTs) are strikingly similar for all agents at the population level. They also cite RPCTs that failed to demonstrate additive benefit to combined agents, whereas other studies are considered exceptions. In this opinion, I propose that three premises be satisfied in order to support the validity of the authors’ arguments:

First premise:

A comprehensive review of all relevant RPCTs, including those of drugs in development and combination therapies, must be included in this analysis to definitely show no demonstrable …

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