Biomarkers and Treatment Plans

Since my diagnosis just over eight years ago, I’ve steadily worked my way through all the biologics except one. Your body can build up a resistance to medications just like it can to disease and mine seems to do an excellent job of it. While a drug might have worked in the beginning, over time I’d need a larger dose until, eventually, it quit being effective at all. In addition, some drugs just didn’t work from the beginning.

The trial and error of RA treatment

Treatment plans for RA are, even in this day and age, largely an exercise in trial-and-error. A rheumatologist will often start with the most common medications and go from there.

A frustrating aspect of living with RA

This is extremely frustrating for those of us who are patients. It can take more than three months for some drugs to be effective. Finding out that it doesn’t work after undergoing months of injections or infusions can be disheartening. It’s not surprising, therefore, that many rheumatologists (and patients!) wish for some kind of screening lab test that could predict which drugs have the best opportunity to work for a particular patient.

Biomarkers to determine RA treatment outcomes

I was really encouraged the other day when I read about the use of biomarkers in predicting the outcome of treatment with rituximab (Rituxan). The article is written for physicians and is therefore very technical so I won’t delve deeply into it, but you can read it here if you’re interested.

The study discussed the use of two biomarkers were very predictive in the success of using Rituximab. Interestingly, the study revealed which patients were less likely to respond to treatment indicating that a different medication should be used. It’s not much of a stretch to think that it might be possible to use similar testing to figure out which drugs would be most successful for a patient.

Is additional testing for biomarkers needed?

Those of us with RA and other inflammatory diseases go through a lot of lab work starting with a slew of tests during the diagnosis phase to actually identify what condition is causing the problems. From there, labs are usually drawn on a regular basis to monitor disease markers and watch for any side effects such as liver damage.

The rituximab study was done on data already available so, in this case, additional lab tests wouldn’t have to be done. But even if there was a new lab test developed, it shouldn’t be a huge effort to add it to the regular testing already done.

I would think that insurance companies would cover the test(s) because it would help avoid paying for very expensive drugs that might not work well.

The need for more research on biomarkers and RA treatment response

Unfortunately, the problem may be just doing the research. This kind of research takes time and money as well as access to the lab and exam results for a reasonable population of patients. Unless undertaken by pharmaceutical companies (that may be limited to researching only their specific products), the studies would need to be done by universities or other research facilities that are always scrambling for funding.

But we are getting closer. The really good news is that each time we find a new drug that works or how it works for a specific patient, the closer we are to finding the actual cause of RA and other inflammatory diseases. That means we’re getting closer to a cure.