The introduction of new therapies for the treatment of multiple sclerosis (MS) is a very recent phenomenon and little is known of their mechanism of action. Moreover, the response is subject to interindividual variability and may be affected by genetic factors, such as polymorphisms in the genes implicated in the pathologic environment, pharmacodynamics, and metabolism of the disease or in the mechanism of action of the medications, influencing the effectiveness of these therapies. This review evaluates the impact of pharmacogenetics on the response to treatment with new therapies in patients diagnosed with MS. The results suggest that polymorphisms detected in the GSTP1, ITGA4, NQO1, AKT1, and GP6 genes, for treatment with natalizumab, ZMIZ1, for fingolimod and dimethyl fumarate, ADA, for cladribine, and NOX3, for dimethyl fumarate, may be used in the future as predictive markers of treatment response to new therapies in MS patients. However, there are few existing studies and their samples are small, making it difficult to generalize the role of these genes in treatment with new therapies. Studies with larger sample sizes and longer follow-up are therefore needed to confirm the results of these studies.

IntroductionMethotrexate (MTX) is the treatment of choice for patients with rheumatoid arthritis (RA). However, it has been found to produce toxicity in some patients. Different polymorphisms can play a part in inter-individual differences in toxicity. Our aim is therefore to determine the influence of gene polymorphisms in the MTX metabolic pathway, such as MTHFR (rs1801133 and rs1801131), MTHFD1 (rs2236225), MTR (rs1805087), and ABCC2 (rs4148396), on toxicity in MTX treatment among Caucasian patients diagnosed with RA.Material and methodsReal-time polymnerase chain reaction (PCR) analysis with TaqMan probes was performed on these polymorphisms in 200 patients in a retrospective study.ResultsPatients with TT genotype and C allele for MTHFR rs1801133 gene polymorphism presented a higher risk of anaemia (p = 0.0304; OR = 3.70; 95% CI: 1.10–12.34) and dizziness (p = 0.0438; OR = 8.15; 95% CI: 1.61–148.68). Patients with MTHFR rs1801131-C allele or CC genotype presented a higher risk of mucositis (p = 0.0188; OR = 3.02; 95% CI: 1.22–7.91), acneiform rash (p = 0.0322; OR = 5.74; 95% CI: 1.34–39.21), and alopecia (p = 0.0072; OR = 5.11; 95% CI: 1.37–17.70). Patients with MTR rs1805087-CC genotype presented a higher risk of anosmia (p = 0.0038; OR = 98.00; 95% CI: 3.16–infinite); patients with the TT genotype or T allele for MTHFD1 rs2236225 presented a higher risk of liver failure (p = 0.00229; OR = 2.34; 95% CI: 1.14–4.96) and alopecia (p = 0.0248; OR = 3.83; 95% CI: 1.10–13.30), and patients with the TT genotype for ABCC2 rs4148396 polymorphism (p = 0.0466; OR = 2.67; 95% CI: 0.98–6.94) presented a higher risk of headaches.ConclusionsPharmacogenomic analysis of these polymorphisms may facilitate decision-making in relation to MTX treatment toxicity among RA patients.

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A875 con metotrexato. Se consideraron horizontes temporales de uno, cinco, diez años y toda la vida del paciente. La unidad de resultado fueron años de vida ajustados por calidad (AVAC). El puntaje inicial del HAQ (Health Assessment Questionnaire) como respuesta clínica de corto y largo plazo se tomó de la literatura y se realizaron comparaciones indirectas. Los costos (expresados en bolívares venezolanos de 2014, Bs.) fueron obtenidos de fuentes oficiales y manuales tarifarios. Para el caso de tofacitinib se asumió paridad de precio con etanercept. La tasa de descuento, 5% para costos y desenlaces. ResultAdos: Para el horizonte temporal de toda la vida del paciente, los costos totales esperados fueron: adalimumab Bs. 2.248.884; etanercept Bs. 1.998.582; infliximab Bs 2.283.026 y tofacitinib Bs. 1.909.658. Los resultados en términos de AVAC fueron: adalimumab 10,4767; etanercept 10,6700; infliximab 10,7172 y tofacitinib 10,9100. ConClusiones: Bajo los supuestos del modelo, el esquema de tratamiento que inicia con tofacitinib es una alternativa costo-ahorradora comparado con los esquemas que inician con adalimumab e infliximab en todos los horizontes temporales considerados. Comparado con el esquema que inicia con etanercept es una alternativa costo-efectiva en los horizontes de 5 y 10 años y costo-ahorradora en los horizontes de 1 año y toda la vida del paciente. PMS8AnáliSiS de CoSto efeCtividAd y CoSto UtilidAd de RitUxiMAb CoMo tRAtAMiento en PACienteS Con ARtRitiS ReUMAtoide, Ante el fAllo o intoleRAnCiA en PRiMeRA líneA de Un Anti-tnf, en el Contexto venezolAno