“Patients have various roadblocks to treatment, and when you push that target domino over, you have to be aware of how it may influence all the dominos around it,” she said. “But we are learning how the deck is stacked in different people. The goal is to develop blood tests to predict which treatments are best for an individual and to guide their dosing for optimal rebalancing of the immune system.”
Merrill and her colleague Judith James, M.D., Ph.D., have led a team of researchers at OMRF and Pfizer to develop and study some of these “biomarkers.” Some day, they may be used to track the impact of targeted therapies throughout the immune system, leading to better outcomes for patients receiving these medications.
Because lupus is caused by different combinations of genetic factors in each patient, there isn't going to be a “one size fits all” drug, she said.
“I hope that doesn't sound bleak, because it really isn't,” she said. “We have the technology now to begin breaking that code, to understand what downstream effects are caused by new lupus drugs and tailor the choice and dose of treatments more effectively to individuals.”
It's slow and tedious work, but the result will be a kind of personalized medicine that can help patients manage lupus more effectively, she said.
OMRF President Stephen Prescott, M.D., said personalized medicine is the great hope for complex genetic diseases like lupus, diabetes and Sjogren's syndrome.
“The discoveries we're making now will help us better understand these diseases in the future, so we can combine therapeutics in the best way possible to treat individual patients,” Prescott said.
Merrill said, “We're going to nail the immune system eventually. In the meantime, we can work to increase the good outcomes in patients by better understanding the possible downstream effects of lupus medications.”
Greg Elwell is a public affairs specialist at the Oklahoma Medical Research Foundation.
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