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HLA-DRB1 typing in rheumatoid arthritis: predicting response to specific treatments
J R O'Dell1, B S Nepom, C Haire
1Department of Internal Medicine, University of Nebraska Medical Center (UNMC), USA.
Objective:
To determine the predictive value of shared epitope alleles for response to treatment in patients with rheumatoid arthritis.
Methods:
Patients from our previously published triple DMARD study were tested for the presence of shared epitope alleles (DRB1 *0401, 0404/0408, 0405, 0101, 1001, and 1402). Patients who were shared epitope positive were then compared with those who were negative to see if there was a differential effect on therapeutic response.
Results:
Shared epitope positive patients were much more likely to achieve a 50% response if treated with methotrexate-sulphasalazine-hydroxychloroquine compared with methotrexate alone (94% responders versus 32%, p < 0.0001). In contrast shared epitope negative patients did equally well regardless of treatment (88% responders for methotrexate-sulphasalazine-hydroxychloroquine versus 83% for methotrexate). Additionally, a trend toward an inverse relation of the gene dose was seen for response to methotrexate treatment (p = 0.05).
Conclusions:
These data suggest that determining shared epitope status may provide clinical information useful in selecting among treatment options.