Journal
NATURE REVIEWS RHEUMATOLOGY
Volume 16, Issue 10, Pages 590-599Publisher
NATURE RESEARCH
DOI: 10.1038/s41584-020-0491-4
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Funding
- MRC [MR/K015346/1, G0800648] Funding Source: UKRI
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In this article, the authors discuss how the use of innovative clinical trial designs could facilitate the efficient evaluation of new and existing drugs in specific subgroups of patients, in order to optimize therapy allocation and address unmet clinical needs. Despite the success of targeted therapies in the treatment of inflammatory arthritides, the lack of predictive biomarkers drives a 'trial and error' approach to treatment allocation, leading to variable and/or unsatisfactory responses. In-depth characterization of the synovial tissue in rheumatoid arthritis, as well as psoriatic arthritis and spondyloarthritis, is bringing new insights into the diverse cellular and molecular features of these diseases and their potential links with different clinical and treatment-response phenotypes. Such progress raises the tantalizing prospect of improving response rates by matching the use of specific agents to the cognate target pathways that might drive particular disease subtypes in specific patient groups. Innovative patient-centric, molecular pathology-driven clinical trial approaches are needed to achieve this goal. Whilst progress is clearly being made, it is important to emphasize that this field is still in its infancy and there are a number of potential barriers to realizing the premise of patient-centric clinical trials.
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