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Biological therapy for rheumatoid arthritis: is personalised medicine possible?


Introduction The management of rheumatoid arthritis (RA) has changed significantly since the introduction of cytokine modulators (biological agents). Approximately 30% of patients with RA fail to respond to treatment. As there is now a choice of agents, it is important to identify what factors may affect a patient's response in order to individualise management, thereby optimising outcomes, minimising risks and maximising cost-effectiveness.

Methods A literature search was undertaken with the search terms, ‘biological agents’, ‘biological therapy’, ‘RA’, ‘prediction’ and ‘response’, using Medline, Embase, the British Society for Rheumatology Biologics Register (BSRBR) website and the review journal Current Opinion in Rheumatology. In addition, a final search using specific drug names (abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab and tocilizumab) was performed.

Results A total of 154 papers were identified. Subsequently, 62 were rejected as not addressing response, 12 were not full papers, and 35 were not considered relevant. A total of 45 studies were reviewed. There are data concerning the predictive value of age (younger age positive predictor), gender (female predictive of non-response to rituximab), disease activity (high baseline Disease Activity Score predictive of remission), functional ability (lower baseline disability predictive) and concomitant methotrexate therapy (positive predictor). Conversely, disease duration and previous number of disease-modifying antirheumatic drugs have not been found to be predictive of response.

Some factors, although associated with response, were not demonstrated to be predictive —for example, autoantibodies, smoking status and the development of antibodies to drugs.

Conclusions Identification of predictive factors, in addition to increasing knowledge of factors that may affect response, can be used to take a more personalised approach to therapeutic choice for patients with RA who require biological therapy.

  • Rheumatology
  • Clinical Pharmacy
  • Pharmacotherapy
  • Clinical Pharmacology

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