The EU-funded SQUEEZE initiative aims to personalize and optimize arthritis treatment by using biomarkers to identify the best drugs for individual patients, Ali Jones explores.
Although powerful treatments exist for rheumatoid arthritis, doctors cannot always predict which drugs will be most effective for each person. EU-funded initiatives aim to change this by optimizing and personalizing care.
Over the past two decades, a wave of new drug treatments for rheumatoid arthritis (RA) have enabled many people to live free from pain, joint swelling, and long-term disability. But for many patients in Europe, finding the right drug still takes months or even years of trial and error.
To change this, researchers, clinicians and patients from seven EU countries plus Norway, Switzerland and the UK have joined forces in an EU-funded initiative called SQUEEZE.
Rather than searching for new rheumatoid arthritis drugs, their goal is to optimize the use of existing rheumatoid arthritis drugs and find new biological clues to guide treatment, thereby improving safety and efficacy for patients.
Professor Daniel Aretach from the Medical University of Vienna, who is coordinating the five-year initiative, treats patients with rheumatoid arthritis at the Rheumatology Center of the Vienna General Hospital.
“Although there are many effective treatments that can control rheumatoid arthritis, they still do not bring enough patients into remission. The challenge is no longer just to develop new drugs, but to maximize the effectiveness of the drugs we already have,” he explained.
Treating arthritis often requires years of trial and error
Rheumatoid arthritis is a chronic autoimmune disease in which the immune system attacks the joints, causing pain, stiffness, inflammation, and fatigue.
It often happens to people between the ages of 30 and 60 who are busy raising a family and building a career.
Without clear guidance about how specific drugs work for individual patients, decisions about arthritis treatment can feel like educated guesses.
Patients may have to switch from one drug to another repeatedly, each time facing new concerns about side effects and safety.
“That uncertainty is frustrating for patients and doctors alike,” Aletaha says.
Reaching remission (a period in which symptoms are significantly reduced or completely gone) sooner means less pain, fatigue, and lower risk of permanent joint damage.
Utilization of biomarkers to guide treatment selection
SQUEEZE researchers’ primary focus is identifying biomarkers, measurable indicators of biological conditions and symptoms, that can help doctors choose the right drug for the right person.
Researchers are analyzing tissue samples taken from affected joints to see if biomarkers at the site of inflammation can predict which treatments will be most effective for individual patients.
They are also testing levels of the harmless but prevalent Torquetenovirus in the blood as a real-time indicator of how strongly a patient’s immune system is suppressed.
Viral levels increase and decrease depending on the intensity of treatment. Monitoring these levels could help doctors identify the sweet spot for drugs that are powerful enough to control the disease, but not so powerful that they increase the risk of infection.
Another focus is optimizing drug dosage and delivery to ensure each drug is used in the best possible way. Some of the project’s research is investigating whether patients in stable remission can safely reduce their doses of expensive biologic drugs, which would lower the risk of side effects and reduce health care costs.
Some researchers are also studying whether changing the way the drug is taken, such as injecting methotrexate rather than swallowing it, can increase the amount of the drug the body can absorb, making it more effective.
By pooling thousands of samples from across Europe, researchers are building a shared dataset that reflects diverse health systems.
“For patients with rheumatoid arthritis, their medications, their illness, and their relationships with doctors and nurses all influence successful outcomes,” Aletaha said.
The hidden wall: Taking medicine correctly
Even the most effective treatments are only effective when taken as prescribed. However, with chronic diseases, starting treatment, taking it correctly, and continuing it over a long period of time is a major challenge.
Dr. Agnes Kocher is part of Professor Sabina de Geest’s team at the University of Basel, Switzerland. They are developing a digital, integrated care model that uses secure online tools to support patients between practices. It also aims to understand why some patients undergo so many drug changes.
“Right now, as a clinician, when we find that the disease is not well controlled, we don’t know whether it’s because the drug isn’t working well or whether it’s an issue of adherence,” Kochel said.
The SQUEEZE care model combines medical and behavioral support to help patients better manage their medications in a real-world setting.
Through an electronic survey linked to the National Patient Registry, the system identifies people who are at low, medium or high risk of non-adherence and the factors contributing to that risk. These factors range from fear of injections and nasty side effects to the difficulty of getting repeat prescriptions and sticking to a treatment plan when combined with other medications.
Each patient is personalized and receives ongoing support from their care team based on their level of risk and individual needs. Patients who skip their weekly dosing due to family events may find it helpful to adjust the timing of their dosing. If you are nervous about injections, you can receive extra support from our specialist nurses.
Equally important, this model creates space for more open conversation. “Patients often tell us that they don’t want to admit to their doctor that they’re struggling with treatment because they don’t want to be seen as a ‘bad patient,'” Kochel says.
The idea is that nurses may be in a better position for patients to confide in because they can spend more time with them and develop a more personal rapport.
Creating patient-informed care models to ensure longevity
The Basel team hopes this new model of care will improve conversations between doctors and patients by allowing doctors to ask the right questions and make decisions about changes in treatment together.
“Changing treatment creates a lot of uncertainty. There’s fear that you’ll go back to square one and the new treatment will make your symptoms worse, that you’ll have more side effects, or that you’ll run out of options.”
The contributions of people living with RA and patient organizations are a hallmark of SQUEEZE.
“This project involves so many patients, it’s very special,” Kochel said.
“It gives us great energy to see that patients really appreciate what we do and want to collaborate with our care model group.”
Because this care model is co-created with patients, it is more acceptable, more realistic for daily clinical practice, and more likely to be used long-term.
From project to practice
With clinical research currently underway and shared data from thousands of patients being collected, the SQUEEZE team looks forward to providing tools and training to help clinicians use biomarkers, dosing strategies, and new models of care in daily practice.
But for Aletaha, the ultimate goal is not the document. “Guidelines alone won’t change practice,” he says.
“It makes a difference when that knowledge is put into practice in the clinic and improves people’s lives. We want all patients to receive the treatment that’s right for them as soon as possible.”
Source link
