A RECENT study has revealed that analysing immune cell diversity in patients with rheumatoid arthritis (RA) through peripheral blood immunophenotyping may improve responses to targeted treatments. With the wide-ranging causes and immune system irregularities present in RA patients, this stratification approach offers hope for more personalised therapeutic strategies.
The study involved more than 500 RA patients who had not yet received biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Researchers used flow cytometry to identify unique immunophenotypic profiles and classified patients into five distinct groups based on immune cell characteristics. In particular, two groups showed notable increases in CD4+ effector memory T cells with CD45RA re-expression, a distinguishing feature that could affect therapeutic outcomes.
Patients were then treated with various b/tsDMARDs, revealing significant differences in treatment success rates among the groups. Patients in the ‘expected’ treatment category, matched with therapies likely to be effective based on their immune profiles, achieved superior results: a 39.9% remission rate at 26 weeks compared to 24.6% in the ‘non-expected’ group, along with a higher likelihood of maintaining low disease activity. This pattern was validated in a second cohort of 183 RA patients, confirming the initial findings.
Additionally, different therapies impacted the distribution of immune cell subsets differently, underscoring the importance of individualised treatment selection. The study authors suggest that blood-based immunophenotyping could become an essential tool in RA treatment, enabling clinicians to predict which patients are most likely to benefit from specific targeted therapies.
This research highlights the promise of a tailored approach to RA treatment, aimed at improving patient outcomes by considering the underlying immune diversity in each individual.
Reference
Kubo S et al. Peripheral blood immunophenotypic diversity in patients with rheumatoid arthritis and its impact on therapeutic responsiveness. Annals of the Rheumatic Diseases. 2024. DOI:10.1136/ard-2024-226228.
