It’s a question for the ages. When patients with rheumatoid arthritis (RA) do not respond to first line treatment with methotrexate, what do you try next?

In a video on Medscape, rheumatology expert Dr. Jonathan Kay with the University of Massachusetts Medical School sat down with Ronald van Vollenhoven, MD, PhD with the Rheumatology unit at the Karolinska Institutet in Stockholm, Sweden to discuss some of the work van Vollenhoven and colleagues have done to help address this question.

At the American College of Rheumatology annual meeting in early November, the van Vollenhoven and colleagues presented data findings to provide insight into how a RA patient’s multibiomarker disease activity or MDBA scores can predict their response to varying additional therapies, if methotrexate does not work for the patient. The MDBA blood test helps determine RA disease activity.

As background: Typically, clinician recommendations will note that if a patient with RA does not respond to treatment with methotrexate, then, their physician may prescribe an additional disease-modifying anti-rheumatic drugs or DMARDs such as sulfasalazine and hydroxychloroquine—making it a triple therapy option. Alternatively, clinicians may recommend an anti-tumor necrosis factor (TNF) agent instead such as infliximab. The latter is the option many clinicians may go with for their patients who aren’t responsive to methotrexate.

Findings presented at ACR 2015 showed that if a patient is on methotrexate and is not doing well on it, but their MDBA score is high, then, they potentially should be on an anti-TNF agent for better results. But, if they are unresponsive to methotrexate and their MBDA score is low, they may do well with triple therapy instead of treatment with an anti-TNF agent.

In the video, Dr. van Vollenhoven notes that the MBDA score helps identify “many different aspects of the inflammatory process, not just acute inflammation,” but also factors that contribute to cartilage degeneration and more. Since the treatments analyzed work against different pathways, MBDA may help clinicians decide which patients should use triple therapy or anti-TNF agents when methotrexate alone isn’t working.

It’s important to note these are results a starting point to help determine how to better provide personalized, targeted treatment for specific patients, but more analysis needs to be done.

Click here to view the full video segment