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Dr Laura Coates has been awarded £1.8M from the National Institute for Health Research (NIHR) to explore the potential for precision medicine in the choice of biologics to reduce inflammation and pain in psoriatic arthritis.

Psoriatic arthritis research

Psoriatic arthritis (PsA) is a type of arthritis that develops in some people with the skin condition psoriasis. It causes joints to become swollen and painful and is a long-term condition that can get progressively worse. It develops in 15% of people with psoriasis affecting around 150,000 people in the UK.

The study (OPTIMISE) is a collaboration with the University of Glasgow and King’s College London. It will test if it’s possible to predict whether people with PsA will respond to two different types of drug (two different types of biologics) leading to a reduction in inflamed joints and pain.

The team will first test if high levels of a type of blood cell, called Th17 cells, predicts a response to either or both of the two biologic drugs. They will then see if combining this blood result with other blood tests or an individual's pattern of arthritis improve the prediction. In this way they hope to develop a blood test that would predict the best biologic drug for each person, offering a more personalised approach and ensuring their disease is controlled quickly improving quality of life. 

Dr Coates said: “We have increasing numbers of drugs for psoriatic arthritis but very little evidence to tell us which drug we should pick for each individual patient. A recent small study in Japan suggested that choosing the biologic drug based on patients' blood Th17 cells could give better results than the doctors' choice. If our larger study supports this evidence, it will remove some of the guesswork for doctors who can’t know how to predict in advance which patient will respond best to each drug.  A simple blood test could predict which drug would be best for each patient before they start on treatment.” 

The OPTIMISE trial will be conducted in the department by the Experimental Medicine and Rheumatology group within the Oxford Clinical Trials Research Unit (OCTRU). If successful, this precision medicine approach could save money for the NHS and most importantly would improve patients' quality of life earlier. 

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