According to Dr. Rigby, the greatest application of Vectra is for predicting people with poor outcomes or for predicting that a patient is in low disease activity even when they are still reporting lots of symptoms. The big question in a patient with painful hands but no swelling is whether the patient’s “amplification of pain pathways is talking or whether it is the synovial inflammation talking. Some say Vectra is very good at that. Others would say why not do musculoskeletal ultrasound of that particular joint and confirm the inflammation.”
But of course the problem remains that, even if it is the inflammation talking, there is still no biomarker that can predict the best treatment for the patient whose disease does not respond adequately to methotrexate or even triple therapy.
The search for the holy grail in RA is a complex one, but one worth doing, Dr. Kremer says. “The stakes are so high. People are suffering with a chronic lifelong disease, and these interventions are very expensive. In fact, the Corrona data show that 55–60% of all RA patients in the U.S. are on some type of biologic drug. In an era of shrinking resources for these expensive drugs, it would save society a lot of money if individuals can be identified up front as better or worse candidates for a particular intervention.”
Kathy Holliman is a medical journalist based in Beverly, Mass.
References
- Robinson WH, Lindstrom TM, Cheung RK, Sokolove J. Mechanistic biomarkers for clinical decision making in rheumatic diseases. Nat Rev Rheumatol. 2013;9:267–276.
- Dennis G Jr., Holweg CTJ, Kummerfield SK, et al. Arthritis Res Ther. 2014;16:R90;1–18.
- Snyder A, Makarov V, Merghoub T, et al. Genetic basis for clinical response to CTLA-4 blockade in Melanoma. N Engl J Med. 2014. Doi:10.1056/NEJMoa1406498.