Farmacogenómica de etanercept, infliximab, adalimumab y metotrexato en artritis reumatoide. Revisión estructurada

Abstract

IntroductionIndividual genetic variability favours the capacity of response and toxicity to the drugs is different in each person. Rheumatoid arthritis reported rates of response to the drugs etanercept, infliximab, adalimumab and methotrexate is close to 60%. This variability can be explained by genetic polymorphisms characteristic of each patient. ObjectiveTo identify genetic polymorphisms reported in scientific articles that may affect the pharmacokinetics and pharmacodynamics of etanercept, infliximab, adalimumab, and methotrexate, and their response in patients with rheumatoid arthritis. Materials and methodA systematic search was performed in PubMed and Medline, with the key terms: “rheumatoid arthritis” and “pharmacogenomic” and “polymorphisms” and “methotrexate” and “infliximab” and “adalimumab” and “etanercept”, obtaining 164 articles, 117 non-duplicates, and 19 articles that met the inclusion criteria. ResultsOf the 19 articles, 2 reported polymorphisms affecting the pharmacokinetics of infliximab, adalimumab, etanercept, methotrexate, and 17, pharmacodynamics. In the 19 articles, 23 polymorphisms of clinical relevance were identified in European, Japanese, Jordanian, and Indian populations. ConclusionsA total of 23 polymorphisms with clinical relevance were identified, which could be the basis for the design of a specific test sequencing in rheumatoid arthritis patients being considered for treatment with infliximab, adalimumab, etanercept, or methotrexate. The practical usefulness of this strategy requires evidence in specific clinical studies, associated with a targeted and personalised genetic test, and its effect on the effectiveness and safety of drug therapy with these drugs prescription.