It’s personal! A novel treatment choice algorithm for PsA
Psoriatic arthritis (PsA) is a chronic form of inflammatory arthritis associated with psoriasis. About 10-30% of patients with psoriasis develop PsA, and it is believed to affect up to 90,000 Canadians. There is currently no cure for PsA, and patient responses to available biologic and other advanced therapies can differ considerably.
A novel treatment algorithm based on T-cell behavior, presented at the annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), may show promise for directing patients to a biologic most likely to produce disease control. This personalized medicine-based approach distinguishes patients by the ratios of expression of different cytokines (tumour necrosis factor [TNF]-alpha, interleukin [IL]-22, IL-17 and interferon-gamma) in peripheral blood T-cells. The treatment decision tree consists of specific immune patterns, and a yes/no response leads to a biologic that inhibits a dominant cytokine.
Though exciting, the proof-of-concept study was designed to test for feasibility, and additional analyses are required to demonstrate a clinical benefit.
Nevertheless, there is a clear need for tools to aid in the selection of therapies most likely to be effective. If successful, not only will this method improve patient outcomes, but also aid in more cost-effective treatment selection.