Which Biologic Agent Will Become the Standard Treatment for Rheumatoid Arthritis?

Once it is known that certain gene sets are differentially regulated by anti-TNF therapy, rheumatologists will have the ability to use this genetic marker information to predict how their patients will respond to a particular therapy. But of course this research is preliminary data on a small pool of patients, and the real challenge which must be undertaken is a long-term study which measures how rheumatoid arthritis patients do going forward on a particular therapy, all the while watching the expression of their genes. Only then will we know which patient will profit most from a particular treatment.

The biologic pipeline is filled with an array of potential candidates for the treatment of rheumatoid arthritis. The day of the knee-jerk response of if-methotrexate-doesn't-work-add-anti-TNF therapy is disappearing. These are all expensive drugs, and a several months' trial can be quite costly if it proves to be a clinical failure. Also, the cost to the patient of time wasted on a therapy doomed to failure must be considered, as bony destruction due to unchecked rheumatoid arthritis can be significant after just a few weeks. It is just a matter of time before the research lab gives us a tool to use in the office, allowing for the accurate prediction of treatment failure or success.