Pharmacogenomics In Rheumatoid Arthritis

There have been significant advances in developing treatments for rheumatoid arthritis (RA) in recent years. The problem is that response to treatment is not universal.

For example, one of the first-line biological treatments for RA is tumor necrosis factor inhibitors (TNFis). However, according to one study, they’re ineffective for up to 30% of RA cases. 

Another critical concern is the lack of biomarkers. These are used to an individualized and personalized treatment approach for every patient.

As a result, a trial-and-error process is needed. While this is crucial to determine optimal therapy, the entire process makes treating RA difficult. 

The good news is that the utilization of genomics to inform precision medicine has now reached the realm of RA. In this article, we’ll delve into how genetic variants solve ineffective treatments and the lack of biomarkers in treating RA. 

Drug Treatment for Rheumatoid Arthritis

Understanding Genomics 

Understanding Genomics 

The National Human Genome Research Institute defines “genomics” as the study of a person’s genome or complete set of DNA. It explores the interactions of genes with one another and with a person’s environment. 

Genomics is different from genetics. “Genetics” specifically studies genes and heredity (i.e., how traits from parents are passed to offspring due to changes in DNA sequence.

In contrast, “genomics”  studies a person’s entire genetic makeup associated with conditions with a broader range of triggers, including asthma, diabetes, heart disease, and asthma.

Genomics in Medicine

The use of genomic information of a person as part of their clinical care is called “genomic medicine.” This is an emerging medical discipline that has been making an impact in various medical fields, including oncology, infectious disease, and rare and undiagnosed diseases. 

Specifically, here’s how genomics is used in medicine: 

  • Effective Diagnosis – This is usually if the cause of a range of symptoms can’t be determined by any other means. 
  • Prenatal tests during pregnancy – This is done by screening (i.e., in case something is wrong with a baby) or tracking a family’s medical history. It helps parents to make plans for the future and informed choices. 
  • Determine genetic conditions – This informs parents whether or not they’re carriers of severe genetic disorders and whether they can pass it on to their offspring. It also informs someone whether they will likely develop an inherited condition later in life despite having no symptoms.
  • To assess risk –  By learning genetic makeup, people can manage the risk of certain illnesses through early positive lifestyle changes, medical intervention, and medication. 

Genomic medicine improves understanding of the links between biology and disease. This benefits on several levels, including personal (e.g., personalized treatments), doctors (e.g., effective diagnoses and treatments), national level, and worldwide. 

The Rise of Pharmacogenomics

Another rising application of genomic medicine is “pharmacogenomics.” It’s a field of research in precision medicine that studies how peoples’ genes affect how they respond to medications. It aims to tailor medical treatments to every person or group of people.

Pharmacogenomics for Rheumatoid Arthritis

Genetic variants determined through pharmacogenomics can be used as biomarkers. This solves the previously mentioned lack of biomarkers in RA treatments. However, pharmacogenomics’ benefits don’t stop there. 

A study explained that genetic variants are stable and remain unaltered, improving the effectiveness of RA treatment and medications.

On the other hand,  gene expression and epigenetics change a lot since they’re highly dependent on environmental factors. 

State-of-the-art genomic machines can also predict a patient’s sensitivity to a particular RA treatment.

This helps health professionals examine the effect of a therapy on a patient’s transcriptional landscape and develop a precision medicine approach. 

Moreover, as mentioned, many patients don’t respond to specific RA therapies, resulting in nothing but expenses.

Using pharmacogenomics doesn’t only predict response but also leads to a stratified medicine approach. This reduces costs and the current trial-and-error approach of many RA treatments to prescribing.

Lastly, many clinicians cycle through RA therapies without clear guidance on which therapy offers the most significant benefit for a particular patient’s condition. This haphazard fashion can be prevented through the use of pharmacogenomics.  

Clinicians can minimize treatment failures and unwanted toxicities by predicting the likelihood of response to a specific therapy. This method is similar to the application of pharmacogenomics to predict toxicities. 

Diagnosis and Treatments of Rheumatoid Arthritis

Diagnosis and Treatments of Rheumatoid Arthritis

Getting an early, accurate diagnosis is key to treating RA effectively. A rheumatologist is the best person to approach in treating arthritis and making a correct diagnosis, using a patient’s medical history, a physical examination, and lab tests (e.g., blood tests like Erythrocyte sedimentation rate (ESR or aka “sed rate”) and C-reactive protein (CRP), and imaging tests). 

Medications for RA are usually aimed at stopping the inflammation or, at least, reducing it to the lowest possible level, hopefully putting it in remission.

Their cost can be as low as $1,000 but no more than $30,000 yearly, depending on the medicine and what one’s health insurance covers.

Besides insurance coverage, promotions like a Hydroxychloroquine Sulfate Savings Offer and state pharmaceutical assistance programs (SPAPs) can help reduce costs and offer financial assistance. If you reside in the United States, find your state’s SPAP in this link. 

Final Thoughts

Pharmacogenomics improves RA patients’ health by helping them know beforehand whether an RA medicine and treatment will benefit them and be safe for them to take.

Knowing this information can also help medical professionals find the ideal approach to treating their RA in the most cost-effective and effective way.