Clinical trial NCT02878161: Predictability Studies on the Efficacy of TNF-α Inhibitors in Chinese RA From "Real World"
Official title: Screening Protein Predictive of Response to Tumor Necrosis Factor-α Inhibitors Treatment in Chinese Rheumatoid Arthritis From "Real World" and Investigating Its Mechanism Through Signal Pathway
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE4
Conditions: Rheumatoid Arthritis
Keywords: rheumatoid arthritis
tumor necrosis factor α inhibitor
predictive
iTRAQ
signal pathway
Lead sponsor: Central South University
Sponsor class: OTHER
First posted: 2016-08-25
Enrollment: 240
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: BASIC_SCIENCE

Brief summary: Rheumatoid arthritis (RA) is a chronic and disabling disease. tumor necrosis factor-a(TNF-a) inhibitors have demonstrated an outstanding performance in relieving joint inflammation and retarding bone erosion involved in RA. However, there is still about one-thirds of RA patients had a poor response to TNF α inhibitors. The Investigators hope to discover prediction protein with a domestic genetic background and finally establish prediction system with Chinese characteristics.

Detailed description: Rheumatoid arthritis (RA) is a chronic and disabling disease. TNF-α inhibitors have demonstrated an outstanding performance in relieving joint inflammation and retarding bone erosion involved in RA. However, there is still about one-thirds of RA patients had a poor response to TNF α inhibitors. Currently the personalized biological treatment is the research hotspot. Recent studies focuses on exploring biomarkers predictive of drug response. The research methods such as genomics, transcriptomics, proteomics, metabolomics and immunocytology, have been applied,but they are not successfully integrated. The related studies in China are still at an initial stage, which necessitates an in-depth study in this area. The investigators' preliminary study showed that TNF-α-308 gene polymorphisms existed in Chinese RA patients and phosphoinositide 3-kinase/Akt signal pathway was activated in proliferated synovial fibroblasts stimulated by TNF-α. Therefore, for the first attempt in China, the investigators intend to screen for differential proteins by using isobaric tags for relative and absolute quantitation(iTRAQ) technique in RA patients receiving anti-TNF-α therapy, and then verify the predictive effects of selected differential proteins from the upstream gene polymorphism to the downstream protein expression. The investigators will also explore the mechanisms of differential proteins involved in TNF-α related signal pathway by using in vitro gene transfer, siRNA interference, and RA animal models. Through this study investigator hope to discover some prediction proteins with a domestic genetic background and finally establish a prediction system with Chinese characteristics.

Eligibility criteria: Inclusion Criteria:

* signed the consents voluntarily
* age between 18-75 years old
* patients were meet the American College of Rheumatology(ACR)

  * European League Against Rheumatism(EULAR) 2009 diagnostic criteria (total scores beyond 6)
* for severe RA patients DAS28-CRP≥5.1
* The participants receiving Infliximab plus Methotrexate will be invited to enroll the study.
* The participants receiving Etanercept plus Methotrexate will be invited to enroll the study.
* The participants receiving Adalimumab plus Methotrexate will be invited to enroll the study.

Exclusion Criteria:

* The patient have the disease history or the disease of cardiovascular, respiratory system, liver, gastrointestinal tract, endocrine, hematology, neurology or psychiatric disturbance, and investigator believe that there are some risks for patients with these disease history or disease when use study drugs, or these disease history or disease will disturb the interpret of data
* Patients with cancer in situ or exist the possibility of cancer malignancies
* Basically or completely loss of mobility, lack self-care ability, such as rely on a wheelchair or bed-ridden .
* Experimental examination display any of the following:

Aspartate aminotransferase or alanine aminotransferase\>1.5 times of the upper limit of the normal value Total bilirubin\>1.5 times of the upper limit of the normal value Total white blood cells \<2500 cells/L absolute neutrophil count \<1200 cells/L lymphocyte count \<750 cells/L platelet\<100000/L

* Patients with symptomatic herpes simplex
* Latent tuberculosis signal (PPD+++ OR T-SPOT\>5 )
* Positive result of the hepatitis B virus (HBV):

HBsAg + Or HBeAg + Or HBeAg + Or HBcAb + Or HBV DNA +

* hepatitis C virus(HCV)+ or HCV RNA +
* HIV infection or HIV+
* 1 months before join the group, from a clinical point of view,patients have a serious infection caused by the virus, bacteria, fungi, or parasites
* Pregnancy 、 location 、prepare for conceive in one years or there is risk to impregnate their partners
* Patients received any biological therapies for 6 months, or participated any other clinical trials of new drugs
* A history of drug allergy
* A history of heavy drink
* vaccinate the live vaccine recently

Primary outcomes:
measure: EULAR (European League Against Rheumatism) response will be assessed among patients of 3 groups
timeFrame: Baseline, Weeks 14
Secondary outcomes:
measure: The changes of TNF level with different EULAR response will be assessed among patients of 3 groups.
timeFrame: Baseline, Weeks 14
measure: The changes of Interest proteins with different EULAR response will be assessed among patients of 3 group.
timeFrame: Baseline, Weeks 14
measure: The SNP (Single nucleotide polymorphism) of gene about TNF with different EULAR response will be assessed among patients of 3 groups.
timeFrame: Weeks 14
measure: The SNP of gene about interest proteins with different EULAR response will be assessed among patients of 3 groups.
timeFrame: Weeks 14
Other outcomes:
Locations:
Study officials:
affiliation: Central South University
name: Fen Li, doctor
role: PRINCIPAL_INVESTIGATOR
References:
citation: van Vollenhoven RF. Switching between anti-tumour necrosis factors: trying to get a handle on a complex issue. Ann Rheum Dis. 2007 Jul;66(7):849-51. doi: 10.1136/ard.2007.069872.
citation: Radstake TR, Svenson M, Eijsbouts AM, van den Hoogen FH, Enevold C, van Riel PL, Bendtzen K. Formation of antibodies against infliximab and adalimumab strongly correlates with functional drug levels and clinical responses in rheumatoid arthritis. Ann Rheum Dis. 2009 Nov;68(11):1739-45. doi: 10.1136/ard.2008.092833. Epub 2008 Nov 19.
citation: Miossec P, Verweij CL, Klareskog L, Pitzalis C, Barton A, Lekkerkerker F, Reiter S, Laslop A, Breedveld F, Abadie E, Flamion B, Dere W, Mpofu S, Goel N, Ethgen D, Mitlak B, Ormarsdottir S, Rao R, Tsouderos Y, Reginster JY; Group for Respect of Ethics and Excellence in Science (GREES). Biomarkers and personalised medicine in rheumatoid arthritis: a proposal for interactions between academia, industry and regulatory bodies. Ann Rheum Dis. 2011 Oct;70(10):1713-8. doi: 10.1136/ard.2011.154252. Epub 2011 Jul 22.
citation: Zeng Z, Duan Z, Zhang T, Wang S, Li G, Gao J, Ye D, Xu S, Xu J, Zhang L, Pan F. Association between tumor necrosis factor-alpha (TNF-alpha) promoter -308 G/A and response to TNF-alpha blockers in rheumatoid arthritis: a meta-analysis. Mod Rheumatol. 2013 May;23(3):489-95. doi: 10.1007/s10165-012-0699-5. Epub 2012 Jul 4.
citation: Kang CP, Lee KW, Yoo DH, Kang C, Bae SC. The influence of a polymorphism at position -857 of the tumour necrosis factor alpha gene on clinical response to etanercept therapy in rheumatoid arthritis. Rheumatology (Oxford). 2005 Apr;44(4):547-52. doi: 10.1093/rheumatology/keh550. Epub 2005 Feb 3.
citation: Miceli-Richard C, Comets E, Verstuyft C, Tamouza R, Loiseau P, Ravaud P, Kupper H, Becquemont L, Charron D, Mariette X. A single tumour necrosis factor haplotype influences the response to adalimumab in rheumatoid arthritis. Ann Rheum Dis. 2008 Apr;67(4):478-84. doi: 10.1136/ard.2007.074104. Epub 2007 Aug 2.
citation: Nishimoto T, Seta N, Anan R, Yamamoto T, Kaneko Y, Takeuchi T, Kuwana M. A single nucleotide polymorphism of TRAF1 predicts the clinical response to anti-TNF treatment in Japanese patients with rheumatoid arthritis. Clin Exp Rheumatol. 2014 Mar-Apr;32(2):211-7. Epub 2013 Dec 9.
citation: Potter C, Hyrich KL, Tracey A, Lunt M, Plant D, Symmons DP, Thomson W, Worthington J, Emery P, Morgan AW, Wilson AG, Isaacs J, Barton A; BRAGGSS. Association of rheumatoid factor and anti-cyclic citrullinated peptide positivity, but not carriage of shared epitope or PTPN22 susceptibility variants, with anti-tumour necrosis factor response in rheumatoid arthritis. Ann Rheum Dis. 2009 Jan;68(1):69-74. doi: 10.1136/ard.2007.084715. Epub 2008 Mar 28.
citation: Padyukov L, Lampa J, Heimburger M, Ernestam S, Cederholm T, Lundkvist I, Andersson P, Hermansson Y, Harju A, Klareskog L, Bratt J. Genetic markers for the efficacy of tumour necrosis factor blocking therapy in rheumatoid arthritis. Ann Rheum Dis. 2003 Jun;62(6):526-9. doi: 10.1136/ard.62.6.526.
citation: Davila-Fajardo CL, Marquez A, Pascual-Salcedo D, Moreno Ramos MJ, Garcia-Portales R, Magro C, Alegre-Sancho JJ, Balsa A, Cabeza-Barrera J, Raya E, Martin J. Confirmation of -174G/C interleukin-6 gene promoter polymorphism as a genetic marker predicting antitumor necrosis factor treatment outcome. Pharmacogenet Genomics. 2014 Jan;24(1):1-5. doi: 10.1097/FPC.0000000000000013.
citation: Coulthard LR, Taylor JC, Eyre S; Biologics in Rheumatoid Arthritis Genetics and Genomics; Robinson JI, Wilson AG, Isaacs JD, Hyrich K, Emery P, Barton A, Barrett JH, Morgan AW, McDermott MF. Genetic variants within the MAP kinase signalling network and anti-TNF treatment response in rheumatoid arthritis patients. Ann Rheum Dis. 2011 Jan;70(1):98-103. doi: 10.1136/ard.2010.133249. Epub 2010 Aug 30.
citation: Potter C, Cordell HJ, Barton A, Daly AK, Hyrich KL, Mann DA, Morgan AW, Wilson AG; Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate (BRAGGSS); Isaacs JD. Association between anti-tumour necrosis factor treatment response and genetic variants within the TLR and NFkappaB signalling pathways. Ann Rheum Dis. 2010 Jul;69(7):1315-20. doi: 10.1136/ard.2009.117309. Epub 2010 May 6.
citation: Tan RJ, Gibbons LJ, Potter C, Hyrich KL, Morgan AW, Wilson AG, Isaacs JD; BRAGGSS; Barton A. Investigation of rheumatoid arthritis susceptibility genes identifies association of AFF3 and CD226 variants with response to anti-tumour necrosis factor treatment. Ann Rheum Dis. 2010 Jun;69(6):1029-35. doi: 10.1136/ard.2009.118406. Epub 2010 May 5.
citation: Cui J, Saevarsdottir S, Thomson B, Padyukov L, van der Helm-van Mil AH, Nititham J, Hughes LB, de Vries N, Raychaudhuri S, Alfredsson L, Askling J, Wedren S, Ding B, Guiducci C, Wolbink GJ, Crusius JB, van der Horst-Bruinsma IE, Herenius M, Weinblatt ME, Shadick NA, Worthington J, Batliwalla F, Kern M, Morgan AW, Wilson AG, Isaacs JD, Hyrich K, Seldin MF, Moreland LW, Behrens TW, Allaart CF, Criswell LA, Huizinga TW, Tak PP, Bridges SL Jr, Toes RE, Barton A, Klareskog L, Gregersen PK, Karlson EW, Plenge RM. Rheumatoid arthritis risk allele PTPRC is also associated with response to anti-tumor necrosis factor alpha therapy. Arthritis Rheum. 2010 Jul;62(7):1849-61. doi: 10.1002/art.27457.
citation: Krintel SB, Essioux L, Wool A, Johansen JS, Schreiber E, Zekharya T, Akiva P, Ostergaard M, Hetland ML. CD6 and syntaxin binding protein 6 variants and response to tumor necrosis factor alpha inhibitors in Danish patients with rheumatoid arthritis. PLoS One. 2012;7(6):e38539. doi: 10.1371/journal.pone.0038539. Epub 2012 Jun 7.
citation: Liu C, Batliwalla F, Li W, Lee A, Roubenoff R, Beckman E, Khalili H, Damle A, Kern M, Furie R, Dupuis J, Plenge RM, Coenen MJ, Behrens TW, Carulli JP, Gregersen PK. Genome-wide association scan identifies candidate polymorphisms associated with differential response to anti-TNF treatment in rheumatoid arthritis. Mol Med. 2008 Sep-Oct;14(9-10):575-81. doi: 10.2119/2008-00056.Liu.
citation: Cui J, Stahl EA, Saevarsdottir S, Miceli C, Diogo D, Trynka G, Raj T, Mirkov MU, Canhao H, Ikari K, Terao C, Okada Y, Wedren S, Askling J, Yamanaka H, Momohara S, Taniguchi A, Ohmura K, Matsuda F, Mimori T, Gupta N, Kuchroo M, Morgan AW, Isaacs JD, Wilson AG, Hyrich KL, Herenius M, Doorenspleet ME, Tak PP, Crusius JB, van der Horst-Bruinsma IE, Wolbink GJ, van Riel PL, van de Laar M, Guchelaar HJ, Shadick NA, Allaart CF, Huizinga TW, Toes RE, Kimberly RP, Bridges SL Jr, Criswell LA, Moreland LW, Fonseca JE, de Vries N, Stranger BE, De Jager PL, Raychaudhuri S, Weinblatt ME, Gregersen PK, Mariette X, Barton A, Padyukov L, Coenen MJ, Karlson EW, Plenge RM. Genome-wide association study and gene expression analysis identifies CD84 as a predictor of response to etanercept therapy in rheumatoid arthritis. PLoS Genet. 2013 Mar;9(3):e1003394. doi: 10.1371/journal.pgen.1003394. Epub 2013 Mar 28.
citation: Umicevic Mirkov M, Cui J, Vermeulen SH, Stahl EA, Toonen EJ, Makkinje RR, Lee AT, Huizinga TW, Allaart R, Barton A, Mariette X, Miceli CR, Criswell LA, Tak PP, de Vries N, Saevarsdottir S, Padyukov L, Bridges SL, van Schaardenburg DJ, Jansen TL, Dutmer EA, van de Laar MA, Barrera P, Radstake TR, van Riel PL, Scheffer H, Franke B, Brunner HG, Plenge RM, Gregersen PK, Guchelaar HJ, Coenen MJ. Genome-wide association analysis of anti-TNF drug response in patients with rheumatoid arthritis. Ann Rheum Dis. 2013 Aug;72(8):1375-81. doi: 10.1136/annrheumdis-2012-202405. Epub 2012 Dec 11.
citation: Marquez A, Ferreiro-Iglesias A, Davila-Fajardo CL, Montes A, Pascual-Salcedo D, Perez-Pampin E, Moreno-Ramos MJ, Garcia-Portales R, Navarro F, Moreira V, Magro C, Caliz R, Ferrer MA, Alegre-Sancho JJ, Joven B, Carreira P, Balsa A, Vasilopoulos Y, Sarafidou T, Cabeza-Barrera J, Narvaez J, Raya E, Canete JD, Fernandez-Nebro A, Ordonez Mdel C, de la Serna AR, Magallares B, Gomez-Reino JJ, Gonzalez A, Martin J. Lack of validation of genetic variants associated with anti-tumor necrosis factor therapy response in rheumatoid arthritis: a genome-wide association study replication and meta-analysis. Arthritis Res Ther. 2014 Mar 11;16(2):R66. doi: 10.1186/ar4504.
citation: Lindberg J, Wijbrandts CA, van Baarsen LG, Nader G, Klareskog L, Catrina A, Thurlings R, Vervoordeldonk M, Lundeberg J, Tak PP. The gene expression profile in the synovium as a predictor of the clinical response to infliximab treatment in rheumatoid arthritis. PLoS One. 2010 Jun 25;5(6):e11310. doi: 10.1371/journal.pone.0011310.
citation: Pachot A, Arnaud B, Marrote H, Cazalis MA, Diasparra J, Gouraud A, Mougin B, Miossec P. Increased tumor necrosis factor-alpha mRNA expression in whole blood from patients with rheumatoid arthritis: reduction after infliximab treatment does not predict response. J Rheumatol. 2007 Nov;34(11):2158-61. Epub 2007 Sep 15.
citation: Sekiguchi N, Kawauchi S, Furuya T, Inaba N, Matsuda K, Ando S, Ogasawara M, Aburatani H, Kameda H, Amano K, Abe T, Ito S, Takeuchi T. Messenger ribonucleic acid expression profile in peripheral blood cells from RA patients following treatment with an anti-TNF-alpha monoclonal antibody, infliximab. Rheumatology (Oxford). 2008 Jun;47(6):780-8. doi: 10.1093/rheumatology/ken083. Epub 2008 Apr 3.
citation: Julia A, Erra A, Palacio C, Tomas C, Sans X, Barcelo P, Marsal S. An eight-gene blood expression profile predicts the response to infliximab in rheumatoid arthritis. PLoS One. 2009 Oct 22;4(10):e7556. doi: 10.1371/journal.pone.0007556.
citation: Stuhlmuller B, Haupl T, Hernandez MM, Grutzkau A, Kuban RJ, Tandon N, Voss JW, Salfeld J, Kinne RW, Burmester GR. CD11c as a transcriptional biomarker to predict response to anti-TNF monotherapy with adalimumab in patients with rheumatoid arthritis. Clin Pharmacol Ther. 2010 Mar;87(3):311-21. doi: 10.1038/clpt.2009.244. Epub 2009 Dec 23.
citation: Meugnier E, Coury F, Tebib J, Ferraro-Peyret C, Rome S, Bienvenu J, Vidal H, Sibilia J, Fabien N. Gene expression profiling in peripheral blood cells of patients with rheumatoid arthritis in response to anti-TNF-alpha treatments. Physiol Genomics. 2011 Apr 12;43(7):365-71. doi: 10.1152/physiolgenomics.00127.2010. Epub 2011 Jan 25.
citation: Wright HL, Thomas HB, Moots RJ, Edwards SW. Interferon gene expression signature in rheumatoid arthritis neutrophils correlates with a good response to TNFi therapy. Rheumatology (Oxford). 2015 Jan;54(1):188-93. doi: 10.1093/rheumatology/keu299. Epub 2014 Aug 13.
citation: Fabre S, Dupuy AM, Dossat N, Guisset C, Cohen JD, Cristol JP, Daures JP, Jorgensen C. Protein biochip array technology for cytokine profiling predicts etanercept responsiveness in rheumatoid arthritis. Clin Exp Immunol. 2008 Aug;153(2):188-95. doi: 10.1111/j.1365-2249.2008.03691.x. Epub 2008 Jun 18.
citation: Hueber W, Tomooka BH, Batliwalla F, Li W, Monach PA, Tibshirani RJ, Van Vollenhoven RF, Lampa J, Saito K, Tanaka Y, Genovese MC, Klareskog L, Gregersen PK, Robinson WH. Blood autoantibody and cytokine profiles predict response to anti-tumor necrosis factor therapy in rheumatoid arthritis. Arthritis Res Ther. 2009;11(3):R76. doi: 10.1186/ar2706. Epub 2009 May 21.
citation: Trocme C, Marotte H, Baillet A, Pallot-Prades B, Garin J, Grange L, Miossec P, Tebib J, Berger F, Nissen MJ, Juvin R, Morel F, Gaudin P. Apolipoprotein A-I and platelet factor 4 are biomarkers for infliximab response in rheumatoid arthritis. Ann Rheum Dis. 2009 Aug;68(8):1328-33. doi: 10.1136/ard.2008.093153. Epub 2008 Jul 29.
citation: Visvanathan S, Rahman MU, Keystone E, Genovese M, Klareskog L, Hsia E, Mack M, Buchanan J, Elashoff M, Wagner C. Association of serum markers with improvement in clinical response measures after treatment with golimumab in patients with active rheumatoid arthritis despite receiving methotrexate: results from the GO-FORWARD study. Arthritis Res Ther. 2010;12(6):R211. doi: 10.1186/ar3188. Epub 2010 Nov 17.
citation: Sakthiswary R, Shaharir SS, Mohd Said MS, Asrul AW, Shahril NS. IgA rheumatoid factor as a serological predictor of poor response to tumour necrosis factor alpha inhibitors in rheumatoid arthritis. Int J Rheum Dis. 2014 Nov;17(8):872-7. doi: 10.1111/1756-185X.12443. Epub 2014 Oct 7.
citation: Mathsson L, Mullazehi M, Wick MC, Sjoberg O, van Vollenhoven R, Klareskog L, Ronnelid J. Antibodies against citrullinated vimentin in rheumatoid arthritis: higher sensitivity and extended prognostic value concerning future radiographic progression as compared with antibodies against cyclic citrullinated peptides. Arthritis Rheum. 2008 Jan;58(1):36-45. doi: 10.1002/art.23188.
citation: Morozzi G, Fabbroni M, Bellisai F, Cucini S, Simpatico A, Galeazzi M. Low serum level of COMP, a cartilage turnover marker, predicts rapid and high ACR70 response to adalimumab therapy in rheumatoid arthritis. Clin Rheumatol. 2007 Aug;26(8):1335-8. doi: 10.1007/s10067-006-0520-y. Epub 2007 Feb 7.
citation: Gonzalez-Alvaro I, Ortiz AM, Tomero EG, Balsa A, Orte J, Laffon A, Garcia-Vicuna R. Baseline serum RANKL levels may serve to predict remission in rheumatoid arthritis patients treated with TNF antagonists. Ann Rheum Dis. 2007 Dec;66(12):1675-8. doi: 10.1136/ard.2007.071910. Epub 2007 Jul 31.
citation: Mavragani CP, La DT, Stohl W, Crow MK. Association of the response to tumor necrosis factor antagonists with plasma type I interferon activity and interferon-beta/alpha ratios in rheumatoid arthritis patients: a post hoc analysis of a predominantly Hispanic cohort. Arthritis Rheum. 2010 Feb;62(2):392-401. doi: 10.1002/art.27226.
citation: Choi IY, Gerlag DM, Herenius MJ, Thurlings RM, Wijbrandts CA, Foell D, Vogl T, Roth J, Tak PP, Holzinger D. MRP8/14 serum levels as a strong predictor of response to biological treatments in patients with rheumatoid arthritis. Ann Rheum Dis. 2015 Mar;74(3):499-505. doi: 10.1136/annrheumdis-2013-203923. Epub 2013 Dec 2.
citation: Kapoor SR, Filer A, Fitzpatrick MA, Fisher BA, Taylor PC, Buckley CD, McInnes IB, Raza K, Young SP. Metabolic profiling predicts response to anti-tumor necrosis factor alpha therapy in patients with rheumatoid arthritis. Arthritis Rheum. 2013 Jun;65(6):1448-56. doi: 10.1002/art.37921.
citation: Chen DY, Chen YM, Chen HH, Hsieh CW, Lin CC, Lan JL. Increasing levels of circulating Th17 cells and interleukin-17 in rheumatoid arthritis patients with an inadequate response to anti-TNF-alpha therapy. Arthritis Res Ther. 2011 Jul 30;13(4):R126. doi: 10.1186/ar3431.
citation: Ceeraz S, Hall C, Choy EH, Spencer J, Corrigall VM. Defective CD8+CD28+ regulatory T cell suppressor function in rheumatoid arthritis is restored by tumour necrosis factor inhibitor therapy. Clin Exp Immunol. 2013 Oct;174(1):18-26. doi: 10.1111/cei.12161.
citation: Tanaka Y, Matsumoto I, Iwanami K, Inoue A, Umeda N, Tanaka Y, Sugihara M, Hayashi T, Ito S, Sumida T. Six-transmembrane epithelial antigen of prostate 4 (STEAP4) is expressed on monocytes/neutrophils, and is regulated by TNF antagonist in patients with rheumatoid arthritis. Clin Exp Rheumatol. 2012 Jan-Feb;30(1):99-102. Epub 2012 Mar 6.
citation: Daien CI, Morel J. Predictive factors of response to biological disease modifying antirheumatic drugs: towards personalized medicine. Mediators Inflamm. 2014;2014:386148. doi: 10.1155/2014/386148. Epub 2014 Jan 12.
citation: Kristensen LE, Bliddal H, Christensen R, Karlsson JA, Gulfe A, Saxne T, Geborek P. Is swollen to tender joint count ratio a new and useful clinical marker for biologic drug response in rheumatoid arthritis? Results from a Swedish cohort. Arthritis Care Res (Hoboken). 2014 Feb;66(2):173-9. doi: 10.1002/acr.22107.
citation: Xie X, Zhang D, Chen JW, Tian J, Ling GH, Li F. Pharmacogenomics of biological treatment in rheumatoid arthritis. Expert Opin Biol Ther. 2014 Feb;14(2):157-64. doi: 10.1517/14712598.2014.859672. Epub 2013 Dec 3.