title: The effect of gene polymorphisms on patient responses to rheumatoid arthritis therapy.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is a systemic disease leading to joint destruction. The therapy of RA is mainly based on disease-modifying anti-rheumatic drugs (DMARDs) and biological drugs. The response to treatment is different among patients. Therefore, we have searched for factors that may predict the efficacy and toxicity during therapy in individual patients.
  
  
  METHODS
  This review presents the role of genetic polymorphisms as predictors of the efficacy and toxicity during the therapy of RA patients with DMARDs (methotrexate, leflunomide, sulfasalazine) and biological drugs (anti-TNF-alpha antagonists, Tocilizumab, Rituximab).
  
  
  CONCLUSIONS
  Despite studies having shown an association between genetic polymorphisms and response to therapy in RA patients, the majority of these findings are still inconclusive and inconsistent. We are still far from applying pharmacogenetic tests in routine clinical practice that can predict the outcome of treatment. Several factors, such as small sample size with low statistical power, variability in the outcome definitions and the heterogeneity of the cohorts, limited number of tested single nucleotide polymorphisms (SNPs), small effect for the selected variant, and a lack of consideration of epigenetic factors, may contribute to the inconsistency observed and may lead to limited success in personalizing therapy.
authors.affiliation: a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Tarnowski
authors.affiliation: b Department of Biochemistry and Molecular Biology , National Institute of Geriatrics, Rheumatology and Rehabilitation , 02-637 Warszawa , Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Paradowska-Gorycka
authors.affiliation: c Department of Pharmacology , Pomeranian Medical University , 70-111 Szczecin , Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Dąbrowska-Zamojcin
authors.affiliation: a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Czerewaty
authors.affiliation: a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland.
authors.forename: Sylwia
authors.initials: S
authors.lastname: Słuczanowska-Głąbowska
authors.affiliation: a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pawlik
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D044127:Epigenesis, Genetic; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D010597:Pharmacogenetics; D020641:Polymorphism, Single Nucleotide; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007155:Immunologic Factors
keywords: polymorphism; rheumatoid arthritis; therapy