ABSTRACT
The advent of biological therapies has revolutionized the management of rheumatoid arthritis, demonstrating effectiveness in controlling clinical and radiological damage. However, 20 to 40% of the patients will not respond to these therapies, which are associated to a very high cost. In addition, non-responder patients are exposed to possible adverse effects. For these reasons, we need to identify predictors of response to these treatments. These predictors are reviewed in this evidence-based paper and classified into genetic and non-genetic. Despite extensive search, nowadays there are no predictors powerful enough to be used in regular clinical practice. Serum factors, the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, are the only factors currently being used to predict the response to specific biological therapy. In the future, probably thanks to new technologies based on genomics, transcriptomics and proteomics, it will be possible to identify genetic predictors of response to biological drugs that will allow us to select suitable patients for a specific biological therapy.
Subject(s)
Arthritis, Rheumatoid/therapy , Biological Therapy , Antibody Specificity , Arthritis, Rheumatoid/blood , Arthritis, Rheumatoid/genetics , Arthritis, Rheumatoid/immunology , Autoantibodies/blood , Autoantibodies/immunology , Autoantigens/immunology , Autoantigens/metabolism , Biomarkers , Cartilage Oligomeric Matrix Protein , Citrulline/metabolism , Cytokines/blood , Extracellular Matrix Proteins/blood , Genome-Wide Association Study , Glycoproteins/blood , Humans , Major Histocompatibility Complex , Matrilin Proteins , Polymorphism, Single Nucleotide , Prognosis , Protein Processing, Post-Translational , Proteome , Rheumatoid Factor/analysis , TranscriptomeABSTRACT
El desarrollo de las terapias biológicas ha supuesto un gran avance en el manejo de la artritis reumatoide (AR) al haber demostrado efectividad en el control de la clínica y daño radiológico. Sin embargo, entre un 20-40% de los pacientes no van a responder a estas terapias, lo que determina un alto coste económico a la vez que los expone a posibles efectos adversos, por lo que se precisa de la identificación de factores predictores de respuesta a ellos. Estos se revisan en el actual trabajo en función de su evidencia científica y se clasifican en genéticos y no genéticos. A pesar de su extensa búsqueda, en la actualidad no disponemos de potentes predictores que puedan ser utilizados en la práctica clínica diaria. Posiblemente a día de hoy sólo los factores séricos, positividad del factor reumatoide (FR) y anticuerpos antipéptido citrulinado (anti-CCP), permiten predecir la respuesta a determinados biológicos. En un futuro, probablemente gracias a las nuevas tecnologías basadas en la genómica, transcriptómica y proteómica se identificarán predictores genéticos que permita seleccionar pacientes idóneos para una determinada terapia biológica(AU)
The advent of biological therapies has revolutionized the management of rheumatoid arthritis, demonstrating effectiveness in controlling clinical and radiological damage. However, 20 to 40% of the patients will not respond to these therapies, which are associated to a very high cost. In addition, non-responder patients are exposed to possible adverse effects. For these reasons, we need to identify predictors of response to these treatments. These predictors are reviewed in this evidence-based paper and classified into genetic and non-genetic. Despite extensive search, nowadays there are no predictors powerful enough to be used in regular clinical practice. Serum factors, the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, are the only factors currently being used to predict the response to specific biological therapy. In the future, probably thanks to new technologies based on genomics, transcriptomics and proteomics, it will be possible to identify genetic predictors of response to biological drugs that will allow us to select suitable patients for a specific biological therapy(AU)
