Precision Medicine in Rheumatology

Nehad Soloman, MD: For many years, we've had no real insight as to how to treat our rheumatic disease, specifically rheumatoid arthritis. It's been a vast trial-and-error approach. We've had toxic agents such as gold and various alkylating agents used in the 60s and 70s. Then in the 80s, the immersion of methotrexate use gave many people pause since they didn't have cancer and why are we using a low-dose cancer drug? Effectively for a while, we floundered. For a good 20 years or so, we floundered until the advent of biologic agents. Biologic agents gave our patients a newfound hope. It gave rheumatologists a little bit more excitement in their life, something more that they can do to prevent disease progression. As a result of modern technology and within the last 2 decades, a relative explosion of new targeted therapies, whether it's targeted synthetic therapies such as JAK inhibitors or drugs that target B-cells or drugs that target interleukin 6 or T-cell molecules. We have choices, and yet we still are a bit in the dark as to therapy selection. And when we talk about things like precision medicine and individualized or personal patient medicine, we need therapies that can be revealed to us through testing. When we talk about precision medicine, we're talking about a test that can help us based on a patient's biology, their genetics, their individual characteristics as to which therapy selection would be appropriate. As it stands right now, we do have a molecular signature test that helps give insight to potential non-response. If there's a gene signature for non-response for TNF, we tend to sway away with about 80%, 90% confidence. That swaying away from the TNF drug will result in improvements in patients. Whereas if we don't follow or heed the advice of the test, then the likelihood of response would be 10% or less. As precision medicine continues to evolve and the holy grail, if you will, becomes viable to us, we'll be able to not only decide which therapies to stay away from, but hopefully, these tests will help us predict or model for us a path forward for our patients that are individualized and not mandated by payers or formulary restrictions.

Transcript Edited for Clarity