Precision Medicine in RA: A New Test for Predicting Anti-TNF Therapies

Announcer:
You’re listening to Conference Coverage on ReachMD, captured on location at the Congress of Clinical Rheumatology’s Annual Meeting in Destin, Florida. Your host is Dr. Madelaine Feldman, Clinical Associate Professor of Medicine at Tulane University Medical School and Vice President of the Coalition of State Rheumatology Organizations.

Dr. Feldman:
This is Dr. Madelaine Feldman. I’m here at the Congress of Clinical Rheumatology and
I’m here with Keith Johnson, who is with Cipher Medicine, and he has an interesting poster all about a new test that can help predict what type of medication might be the best or may be the worst for a patient with rheumatoid arthritis. Keith, tell us a little bit about this.

Dr. Johnson:
So we realized about a year ago that there was a big need for a test, particularly in rheumatology, to predict who would and who would not respond to anti-TNF therapies, and we heard this from both rheumatologists and from the insurance companies.

Dr. Feldman:
Yes, there does seem to be a trend towards precision medicine. Tell us a little bit more about this test.

Dr. Johnson:
Right, Maddie, this is, as you’ve said, is a precision medicine test. It’s based on a gene expression profile that we determine at baseline from a patient who’s about to start a biologic therapy, and we take a small sample of blood, generate the gene expression profile, and from that profile we can predict with very high precision who will not respond to anti- TNF therapies and therefore enable them to be offered an alternative approved therapy.

Dr. Feldman:
So, Keith, what do you think is going to be the most important outcome with this test?

Dr. Johnson:
Well, so as you are probably aware, not many patients actually achieve their treatment targets with anti-TNFs, maybe only about a third, and so as a result of this test, those who do get anti-TNFs will have a much higher probability of responding and achieving their treatment targets, and those who are put on alternative therapies will have a much better chance of responding to those than they will have to anti-TNFs, so the outcome will be more patients reaching their treatment targets.

Dr. Feldman:
Well, this is really exciting. As a practicing rheumatologist, it would be extremely helpful to have a test in guiding us towards the first biologic that a patient might need. Is this test available now? And if not, when do you anticipate it being available?

Dr. Johnson:
No, the test is not available now. This is our proof of concept. We’ve done a very rigorous scientific test with the data we have, but our next step is to run a couple of clinical trials, which we aim to get completed early in 2020, and then to offer the test to rheumatologists so that they can get more patients to their targets.

Dr. Feldman:
Thank you. This is really exciting.

Dr. Johnson:
You’re very welcome, Maddie. It’s a pleasure.

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