Study Finds Microbiome Predicts Treatment Response in Rheumatoid Arthritis Patients

In patients with rheumatoid arthritis (RA), treatment with DMARDs appears to be able to restore a disrupted microbiome. In addition, microbiome status can be used to predict the likelihood of response to DMARDs.

DMARDs are the first line treatment for RA. However, effectiveness is difficult to predict and long-term results are variable. The gut microbiome is known to play a critical role in prodromal and early RA, with an abundance of Prevotella spp. Clinical response to treatment may be mediated by the microbiome, but few large-scale studies have been conducted. This multicenter, longitudinal study evaluated whether the microbiome was associated with and predicted response to DMARD treatment. The microbiome in feces and saliva was studied in DMARD-naïve UK patients, who were newly diagnosed at the time of DMARD initiation. Clinical data and samples were collected at baseline (n = 144) and after 6 (n = 117) and 12 weeks (n = 95) of treatment with a DMARD (usually methotrexate with/without hydroxychloroquine). Pooled samples (n = stool 365, n = saliva 365) were used for gunshot sequencing. Disease activity was measured at each time point and a clinically relevant minimal improvement was determined.

A total of 26 stool microbes were found to decrease in those who showed minimal clinically relevant improvement. Prevotella spp. and Streptococcus spp. The main rates were decreased after 6 weeks and 12 weeks of treatment with DMARDs, respectively. In addition, the baseline microbiome of DMARD-naïve patients was indicative of future response.

Source:

Danckert NP, Freidin MB, Granville Smith I, et al. Treatment response in rheumatoid arthritis is predicted by the microbiome: a large observational study in DMARD-naïve patients in the UK. Rheumatology (Oxford). 2024 Jan 30. Online ahead of print.