Alvin Wells, MD, PhD: Informing Treatment Strategy for Rheumatic Disease With PrismRA

Clinicians treating patients with rheumatic diseases, including rheumatoid arthritis (RA) and psoriatic arthritis (PsA), have many factors to take into consideration when making decisions on treatment plans for their patients. Treatment options now include conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), biologic DMARDs, and targeted synthetic DMARDs. To help with testing and monitoring of these patients, clincians may benefit from a more standardized and rigorous decision making and checklist system.

Alvin Wells, MD, PhD, director of rheumatology at Advocate Aurora Health, has developed a pneumonic P system to ensure meticulous testing of all relevant factors for patients with rheumatic disease. These include Purified protein derivative/IGRA/T spot assay; Posterior, anterior, and lateral chest X-ray; Panel for hepatitis B; Pneumococcal vaccine; Pox (varicella) titer; Panel for lipids; Pregnancy test; Procalcitonin (PCT) level; and “Phungal” (fungal) test/b-D-glucan test.

Wells also noted that he is adding on another “P” to include the PrismRA test, which is designed to predict which patients with RA are unlikely to respond to tumor necrosis factor inhibitor therapy. It is covered by Medicare for certain patients with rheumatoid arthritis as of October 15, 2023. Of note, this test and report have not been reviewed, cleared, or approved by the Food and Drug Administration.

“How do you pick and choose which drug we use? It's like throwing a dart with a blindfold on, whatever sticks. That's what we use and what you get. Those days are gone. Now we're in the era of using not only evidence-basedmedicine but using artificial intelligence so that if a patient does present with certain patient profile that I want to give them the best therapy possible, that they have the thehighest likelihood of responding," Wells told HCPLive.

Relevant disclosures for Wells include Abbvie, Bristol Myers Squibb, and others. Quotes have been edited for clarity.

REFERENCE

Wells AF, Haddad R. Remember Your Ps: Some Considerations for Initial Testing and Ongoing Monitoring for Patients on DMARDs. Rheumatol (Sunnyvale). 2020:(10):265. doi: 10.35248/2161-1149.20.10.265.