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Can Precision Medicine Redefine Autoimmune Disease Treatment?

Precision medicine is often associated with cancer.  But the practice of finding the right medicine for the right patient at the right time could also revolutionize the treatment of autoimmune diseases.  

Precision medicine involves using personal or genetic information to tailor a patient’s medical care.  In oncology, that can entail genetic testing on a tumor biopsy, allowing the physician to treat based on personalized factors rather than on the tumor’s location in the body.  The approach has provided important new options for cancer treatment.

When it comes to autoimmune diseases, precision medicine also holds promise.  Like cancer, some autoimmune diseases take on highly individualized forms. Lupus is one example.  Meanwhile, diseases such as rheumatoid arthritis affect a heterogeneous population. The disease can impact a 30-year-old mother as much as it can a 70-year-old retiree.  Just as the people themselves are different, so too are their experiences with autoimmune diseases. And responses to treatment vary widely.

Precision medicine has a number of applications for autoimmune disease treatment.  Treating to target for rheumatoid arthritis is one example.  This involves a health care provider and patient setting an individualized goal for disease remission, selecting a medication and then testing periodically to gauge the patient’s progress toward that goal.  

By coupling a personalized approach with emerging technology, precision diagnostics could also play a role in encouraging patient-centered care for people living with autoimmune diseases.  For example, precision testing could soon allow health care providers to use a blood sample to predict whether a patient with rheumatoid arthritis or ulcerative colitis will respond to medications called anti-TNF therapies.  Ulcerative colitis is an autoimmune disease marked by inflammation of the digestive tract.  

Anti-TNF medications can be highly effective, but identifying which patients benefit from an anti-TNF can be costly and time consuming.  Nearly one in three patients doesn’t respond to anti-TNF medications.  Those who do may undergo several years of trial and error before achieving optimal results.  Precision diagnostics can guide personalized treatment decisions about anti-TNF medications, saving patients the frustration, side effects, and cost of trying and failing multiple drugs.  

Precision medicine is still an emerging concept in autoimmune disease treatment.  But as rheumatologist Meenakshi Jolly, MD, explained, precision medicine could boost health care providers’ ability to select “favorable treatment options” and predict outcomes. Through precision medicine is not yet the standard of care, Dr. Jolly confirmed, “we’re headed in that direction.”  

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