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Ann Rheum Dis 1998;57:209-213 ( April )

Extended reports

HLA-DRB1 typing in rheumatoid arthritis: predicting response to specific treatments James R O'Dell,a b Barbara S Nepom,d Claire Haire,a Vivian H Gersuk,d Lakshmi Gaur,d Gerald F Moore,a Walter Drymalski,c William Palmer,c P James Eckhoff,c Lynell W Klassen,a b Steven Wees,c Geoffrey Thiele, Gerald T Nepomd

a Department of Internal Medicine, University of Nebraska Medical Center (UNMC), USA, b Omaha Veterans Affairs Medical Center, USA, c Affiliated Rheumatoid Arthritis Investigational Network (RAIN) clinics, USA, d Virginia Mason Research Center (VMRC), Seattle, WA, USA

Correspondence to: Dr J R O'Dell, University of Nebraska Medical Center, Department of Internal Medicine, 600 South 42nd Street, Omaha, Nebraska 68198-3025, USA.

Accepted for publication 4 March 1998

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.

Keywords: DRB1; rheumatoid arthritis; combination treatment; shared epitope

© 1998 by Annals of the Rheumatic Diseases


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