Summary And Future Directions

Rheumatology is currently in an exciting era of unprecedented new drug development. In addition, the old paradigm of sequential monotherapy with DMARDs is being superseded by the use of DMARD combinations and the introduction of biologic drugs. The use of drugs is still, however, limited by adverse events and limited efficacy and also, in the case of biologics, by the high unit costs of these agents. The study of pharmacogenetics in rheumatology is, as can be seen, at an early stage. In most cases, polymorphisms in a single gene have been studied in isolation. Even using this approach with its inherent limitations, several genes of interest have been identified that may predict efficacy and/or adverse events and need confirmation. There is also clearly a need to extend this work to study drug pathways and gene-gene interactions of relevance more completely. With regard to the biologic agents, pharmacogenetics offers the opportunity to examine predictors of response and nonresponse that may allow better targeting of these expensive therapies to the right patient groups. In the next few years, substantial progress will be made in delineating the genetic contribution to the kinetics and mode of action of the drugs employed in rheumatology.

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