For patients with rheumatoid arthritis (RA), analyzing immune cell diversity in peripheral blood revealed five major immunotype groups, each exhibiting a different response to various biologic or targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs). This is according to a 2024 study published in Annals of the Rheumatic Disease that aimed to stratify the patients based on their immunophenotypes, providing a basis for precision medicine.
“The primary focus in the treatment strategy for RA is the achievement of precision medicine,” explains first author Satoshi Kubo, MD, PhD, an associate professor in the Department of Molecular Targeted Therapies of the University of Occupational and Environmental Health, Kitakyushu, Japan. “In this study, we analyzed immunophenotyping data from the peripheral blood of over 700 RA patients who had never received molecular targeted therapies, and we discovered three significant insights.
Dr. Kubo
“First, the immunophenotypes of these patients are not uniform, but can be categorized into five distinct clusters. Second, each cluster, defined by immune phenotype, responds differently to various molecular targeted therapies. Third, a subset known as CD4 TEMRA may play a critical role in the pathology of some patients. The significance of these findings is as follows.
“The treatment of RA, as recommended by EULAR, involves phases 1, 2 and 3, with five classes of molecular targeted drugs used in phase 2 and beyond. However, there are no biomarkers for selecting these treatments. If it were feasible to implement the optimal molecular targeted therapy from the beginning—essentially employing a precision-medicine approach—the treatment of RA could be fundamentally transformed. Despite considerable efforts by many researchers, this goal has yet to be realized.”
