Current Care Therapy Selection for RA Relies on Trial-and-Error

Rheumatoid arthritis (RA) affects roughly 1.6 million people in the US and as much as 1% of the population worldwide.¹ This chronic autoimmune disease attacks the lining of the joints on both sides of the body causing inflammation and pain. It can also lead to permanent joint damage as well as other complications in the eyes, mouth, and cardiovascular system. While remission is possible within 3 months with early treatment, the process of diagnosis and starting a b/tsDMARD can often take almost 2 years.^2,3

A typical patient journey with RA can look like this:

Taking a closer look at this timeline we see that diagnosis of RA itself can take up to 8.5 months from the onset of symptoms.²

Additionally, once a patient is diagnosed and they are finally able to start treatment, a csDMARD such as methotrexate is most commonly the first treatment prescribed. Many, however, will have an inadequate response after 3-6 months without sufficient improvement to their disease and end up looking to add a b/tsDMARD for further relief and disease management.

Unfortunately, with over 20 different drug treatment options to choose from, selection of the right b/tsDMARD for each RA patient does not have a clear path and becomes a journey of trial-and-error.

Without clear direction from clinical guidelines on therapy selection, up to 90% of patients with RA are treated with TNFi therapies as a first-line biologic.^4,5 According to a publication by Dr. Jeffrey Curtis, only about 1/3 of patients with RA achieve an ACR50 response at 6 months with a biologic after failing methotrexate.⁶

All the while the disease continues to progress causing more pain and discomfort and increasing additional risk factors.

This now becomes a race against time for many patients which can lead to poor outcomes. Patients with RA with uncontrolled disease activity experience:

At Scipher Medicine®, we believe there is a better way to treat these patients and have developed the  PrismRA® test to improve upon this trial-and-error process. The PrismRA test is a precision medicine test that looks at 23 biologic features to predict inadequate response to TNFi therapy in adult patients with RA. With the addition of PrismRA to the care pathway, our goal is to help guide treatment selection for RA to help find the right medication for each patient sooner, getting them back to their lives and avoiding poor outcomes.¹³

To learn more about how we developed PrismRA read about our research and development process

1. Sacks JJ, Luo YH, Helmick CG. Prevalence of specific types of arthritis and other rheumatic conditions in the ambulatory health care system in the United States, 2001-2005. Arthritis Care Res (Hoboken). 2010 Apr;62(4):460-4. doi: 10.1002/acr.20041. PMID: 20391499. 2. Barhamain AS, Magliah RF, Shaheen MH, Musassar SF et al. The journey of rheumatoid arthritis patients: a review of reported lag times from the onset of symptoms. Open Access Rheumatol. 2017 Jul28;9:139-150. Doi: 10.2147/OARRR.S138830. PMID: 28817904; PMCID: PMC5546831. 3. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2021 Jul;73(7):924-939. Doi: 10.1002/acr.24596. Epub 2021 Jun 8. PMID: 34101387; PMCID:PMC9273041 4. Jin Y, Desai RJ, Liu J, et al. Factors associated with initial or subsequent choice of biologic disease-modifying antirheumatic drugs for treatment of rheumatoid arthritis. Arthritis Res Ther. 2017 Jul 5;19(1):159. Doi: 10.1186/s13075-017-1366-1. 5. Curtis JR, Zhang J, Xie F, et al. Use of oral and subcutaneous methotrexate in rheumatoid arthritis patients in the United States. Arthritis Care Res (Hoboken). 2014 Nov;66(11):1604-11. Doi: 10.1002/acr.22383. 6. Curtis JR, Jain A, Askling J, et al. A comparison of patient characteristics and outcomes in selected European and U.S. rheumatoid arthritis registries. Semin Arthritis Rheum. 2010 Aug;40(1):2-14.e1. doi: 10.1016/j.semarthrit.2010.03.003. 7. Grabner M, Boytsov NN, Huang Q, et al. Costs associated with failure to respond to treatment among patients with rheumatoid arthritis initiating TNFi therapy: aretrospective claims analysis. Arthritis Res Ther. 2017;19(1):92. Published 2017 May 15. doi:10.1186/s13075-017-1293-1. Boytsov N, Harrold LR, Mason MA, et al. Increased healthcare resource utilization in higher disease activity levels in initiators of TNF inhibitors among US rheumatoid arthritis patients. Curr Med Res Opin. 2016;32(12):1959-1967. doi:10.1080/03007995.2016.1222515. 9. Bergman M, Zhou L, Patel P, Sawant R, Clewell J, Tundia N. Healthcare Costs of Not Achieving Remission in Patients with Rheumatoid Arthritis in the United States: A Retrospective Cohort Study. Adv Ther. 2021;38(5):2558-2570. doi:10.1007/s12325-021-01730-w. 10. Strand V, Tundia N, Song Y, Macaulay D, Fuldeore M. Economic Burden of Patients with Inadequate Response to Targeted Immunomodulators for Rheumatoid Arthritis. J Manag Care Spec Pharm. 2018;24(4):344-352. doi:10.18553/jmcp.2018.24.4.344. 11. Karpouzas GA, Szekanecz Z, Baecklund E, et al. Rheumatoid arthritis disease activity and adverse events in patients receiving tofacitinib or tumor necrosis factor inhibitors: a post hoc analysis of ORAL Surveillance. Ther Adv Musculoskelet Dis. 2023;15:1759720X231201047. Published 2023 Nov 6. doi:10.1177/1759720X231201047. 12. Solomon DH, Reed GW, Kremer JM, Curtis JR, Farkouh ME, Harrold LR, Hochberg MC, Tsao P, Greenberg JD. Disease activity in rheumatoid arthritis and the risk of cardiovascular events. Arthritis Rheumatol. 2015 Jun;67(6):1449-55. doi: 10.1002/art.39098. 13. Arts EE, Fransen J, Den Broeder AA, van Riel PLCM, Popa CD. Low disease activity (DAS28≤3.2) reduces the risk of first cardiovascular event in rheumatoid arthritis: a time-dependent Cox regression analysis in a large cohort study. Ann Rheum Dis. 2017 Oct;76(10):1693-1699. doi: 10.1136/annrheumdis-2016-210997 13. Curtis JR, Strand V, Golombek S, et al. Patient outcomes improve when a molecular signature test guides treatment decision-making in rheumatoid arthritis. Expert Rev Mol Diagn. 2022 Nov;22(10):973-982. Doi: 10.1080/14737159.2022.2140586.