A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients.
Measurement of MRP8/14 serum levels has shown potential in predicting clinical response to different biological agents in rheumatoid arthritis (RA). We aimed to develop a treatment algorithm based on a prediction score using MRP8/14 measurements and clinical parameters predictive for response to dif...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2016-01-01
|
| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4814133?pdf=render |
| _version_ | 1818362867364134912 |
|---|---|
| author | S C Nair P M J Welsing I Y K Choi J Roth D Holzinger J W J Bijlsma J M van Laar D M Gerlag F P J G Lafeber P P Tak |
| author_facet | S C Nair P M J Welsing I Y K Choi J Roth D Holzinger J W J Bijlsma J M van Laar D M Gerlag F P J G Lafeber P P Tak |
| author_sort | S C Nair |
| collection | DOAJ |
| description | Measurement of MRP8/14 serum levels has shown potential in predicting clinical response to different biological agents in rheumatoid arthritis (RA). We aimed to develop a treatment algorithm based on a prediction score using MRP8/14 measurements and clinical parameters predictive for response to different biological agents.Baseline serum levels of MRP8/14 were measured in 170 patients starting treatment with infliximab, adalimumab or rituximab. We used logistic regression analysis to develop a predictive score for clinical response at 16 weeks. MRP8/14 levels along with clinical variables at baseline were investigated. We also investigated how the predictive effect of MRP8/14 was modified by drug type. A treatment algorithm was developed based on categorizing the expected response per drug type as high, intermediate or low for each patient and optimal treatment was defined. Finally, we present the utility of using this treatment algorithm in clinical practice.The probability of response increased with higher baseline MRP8/14 complex levels (OR = 1.39), differentially between the TNF-blockers and rituximab (OR of interaction term = 0.78), and also increased with higher DAS28 at baseline (OR = 1.28). Rheumatoid factor positivity, functional disability (a higher HAQ), and previous use of a TNF-inhibitor decreased the probability of response. Based on the treatment algorithm 80 patients would have been recommended for anti-TNF treatment, 8 for rituximab, 13 for another biological treatment (other than TNFi or rituximab) and for 69 no recommendation was made. The predicted response rates matched the observed response in the cohort well. On group level the predicted response based on the algorithm resulted in a modest 10% higher response rate in our cohort with much higher differences in response probability in individual patients treated contrary to treatment recommendation.Prediction of response using MRP8/14 levels along with clinical predictors has potential in personalizing treatment for RA patients starting biological anti-rheumatic treatment, and might increase cost-effectiveness. |
| first_indexed | 2024-12-13T21:39:24Z |
| format | Article |
| id | doaj.art-244baf6716a743a3939bbbc47b15a0cc |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-13T21:39:24Z |
| publishDate | 2016-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-244baf6716a743a3939bbbc47b15a0cc2022-12-21T23:30:36ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01113e015236210.1371/journal.pone.0152362A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients.S C NairP M J WelsingI Y K ChoiJ RothD HolzingerJ W J BijlsmaJ M van LaarD M GerlagF P J G LafeberP P TakMeasurement of MRP8/14 serum levels has shown potential in predicting clinical response to different biological agents in rheumatoid arthritis (RA). We aimed to develop a treatment algorithm based on a prediction score using MRP8/14 measurements and clinical parameters predictive for response to different biological agents.Baseline serum levels of MRP8/14 were measured in 170 patients starting treatment with infliximab, adalimumab or rituximab. We used logistic regression analysis to develop a predictive score for clinical response at 16 weeks. MRP8/14 levels along with clinical variables at baseline were investigated. We also investigated how the predictive effect of MRP8/14 was modified by drug type. A treatment algorithm was developed based on categorizing the expected response per drug type as high, intermediate or low for each patient and optimal treatment was defined. Finally, we present the utility of using this treatment algorithm in clinical practice.The probability of response increased with higher baseline MRP8/14 complex levels (OR = 1.39), differentially between the TNF-blockers and rituximab (OR of interaction term = 0.78), and also increased with higher DAS28 at baseline (OR = 1.28). Rheumatoid factor positivity, functional disability (a higher HAQ), and previous use of a TNF-inhibitor decreased the probability of response. Based on the treatment algorithm 80 patients would have been recommended for anti-TNF treatment, 8 for rituximab, 13 for another biological treatment (other than TNFi or rituximab) and for 69 no recommendation was made. The predicted response rates matched the observed response in the cohort well. On group level the predicted response based on the algorithm resulted in a modest 10% higher response rate in our cohort with much higher differences in response probability in individual patients treated contrary to treatment recommendation.Prediction of response using MRP8/14 levels along with clinical predictors has potential in personalizing treatment for RA patients starting biological anti-rheumatic treatment, and might increase cost-effectiveness.http://europepmc.org/articles/PMC4814133?pdf=render |
| spellingShingle | S C Nair P M J Welsing I Y K Choi J Roth D Holzinger J W J Bijlsma J M van Laar D M Gerlag F P J G Lafeber P P Tak A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients. PLoS ONE |
| title | A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients. |
| title_full | A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients. |
| title_fullStr | A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients. |
| title_full_unstemmed | A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients. |
| title_short | A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients. |
| title_sort | personalized approach to biological therapy using prediction of clinical response based on mrp8 14 serum complex levels in rheumatoid arthritis patients |
| url | http://europepmc.org/articles/PMC4814133?pdf=render |
| work_keys_str_mv | AT scnair apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT pmjwelsing apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT iykchoi apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT jroth apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT dholzinger apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT jwjbijlsma apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT jmvanlaar apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT dmgerlag apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT fpjglafeber apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT pptak apersonalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT scnair personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT pmjwelsing personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT iykchoi personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT jroth personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT dholzinger personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT jwjbijlsma personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT jmvanlaar personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT dmgerlag personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT fpjglafeber personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients AT pptak personalizedapproachtobiologicaltherapyusingpredictionofclinicalresponsebasedonmrp814serumcomplexlevelsinrheumatoidarthritispatients |