In an article published in NPR, experts described how a novel blood test called PrismRA could help physicians better predict which treatment options may be most effective in patients with rheumatoid arthritis, stressing the need for rheumatoid arthritis treatment protocols to change in order to minimize ineffective therapy regimens and establish personalized care.
The experts explained that 90% patients often begin treatment for advanced arthritis with adalimumab after not responding to first-line treatments, but about 50% of patients also do not respond to adalimumab. For one such patient, 60-year-old Patti Schulte, treatment with adalimumab and etanercept was unsuccessful. Although her physician recommended she take abatacept, her insurance provider insisted she first receive infliximab. Only after demonstrating no benefit with infliximab and experiencing a severe allergic reaction—which was alleviated with prednisone—was Ms. Schulte prescribed abatacept. However, receipt of prednisone caused her vertebrae to weaken, and she was forced to retire early. Physicians have continuously expressed frustration over having to comply with uninformed decisions made by insurance providers that they know may be incorrect. Although adalimumab may be just as effective as other treatments, insurance providers often favor the drug because of the large rebates they receive for selecting it.
Utilizing clinical factors, gene patterns, and blood tests, PrismRA was found to be capable of predicting which patients may not respond to adalimumab in 60% of cases. The experts underscored that the blood test may save insurance providers thousands of dollars and reduce the number of drugs patients need to trial before finding the most effective treatments. While the test is rarely covered by insurance and may not be useful in all instances, in October 2023, the Centers for Medicare & Medicaid began supplying reimbursements for PrismRA. The experts hope its introduction may inspire the development of other tests to better personalize treatments for patients with rheumatic diseases.