A New Year and New Era for personalized medicine?
Welcome to the January edition of #chatJRheum. As we enter a new year, are we also entering a new era of personalized medicine in rheumatoid arthritis (RA)?
This month’s article presents data from the large US Corrona RA registry. The study seeks to answer whether anti-CCP serologic status is associated with treatment response to either Abatacept or TNF-inhibitor therapy.
The results show that in patients on Abatacept, there was a significant decrease in the CDAI score from baseline of 8.5 among anti-CCP positive patients versus a decrease of 4.0 in the anti-CCP negative serology group. Response on TNF-inhibitor therapy proved different. Although patients showed improved disease activity, there was no difference in change from baseline by anti-CCP serology status. Secondary endpoint analysis of remission rate, low disease activity, HAQ, and ACR response showed significant differences, but only in patients taking Abatacept.
These findings should be interpreted in the context of some limitations. The first is that this is an observational study with data collected from an uncontrolled patient database. The second, is that there were population differences among the Abatacept and anti-TNF inhibitor groups, most notably the use of prior biologics. These inconsistencies likely impacted the observed response rates, but aren’t surprising given the uncontrolled assignment of patients in this “real-world” setting.
A previous randomized control trial, AMPLE, compared Abatacept and Adalimumab in biologic naïve patients. It showed that Abatacept was more effective in anti-CCP positive patients, consistent with the new “real-world” data from the Corrona registry.
Some intriguing questions are raised by this study in light of personalized medicine. Now that we have many effective treatments for RA, we are increasingly looking for guidance on how to individualize our management by selecting the most efficacious treatment on the right patient.
Can anti-CCP be used as an effective biomarker to guide treatment and predict response? Should we change our treatment strategies based on serology status?
I welcome your thoughts, comments or questions on this month’s #chatJRheum forum.
- Sarah Troster, forum moderator