HLA-DRB1 typing in rheumatoid arthritis: predicting response to specific treatments.
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.
Department of Internal Medicine, University of Nebraska Medical Center (UNMC), USA.
J R
JR
O'Dell
B S
BS
Nepom
C
C
Haire
V H
VH
Gersuk
L
L
Gaur
G F
GF
Moore
W
W
Drymalski
W
W
Palmer
P J
PJ
Eckhoff
L W
LW
Klassen
S
S
Wees
G
G
Thiele
G T
GT
Nepom
D000328:Adult; D000368:Aged; D000483:Alleles; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D000939:Epitopes; D005260:Female; D006684:HLA-DR Antigens / Q000235:genetics; D059811:HLA-DRB1 Chains; D006650:Histocompatibility Testing; D006801:Humans; D006886:Hydroxychloroquine / Q000008:administration & dosage; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D018579:Patient Selection; D012460:Sulfasalazine / Q000008:administration & dosage; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D000939:Epitopes; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; C553505:HLA-DRB1*04:01 antigen; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D008727:Methotrexate