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Exagen, Medco Research Institute Aim to Improve Dosing Decisions for Rheumatoid Arthritis

By a GenomeWeb staff reporter

NEW YORK (GenomeWeb News) – Specialty diagnostics laboratory Exagen and Medco Research Institute today announced they have begun a pilot program aimed at helping physicians make better dosing decisions for a rheumatoid arthritis medication.

Called the Novel Interventions in Methotrexate Boosts Levels of Effectiveness, or NIMBLE, the program specifically targets low-dose methotrexate therapy (MTX) — a safe, relatively low-cost, and effective therapy for RA, which is difficult to optimize for individual patients because of the high variability in absorption, excretion, and metabolism rates for each patient.

NIMBLE will use Exagen's Avise PG lab test to measure MTX polyglutamate levels, the active metabolites of MTX. The measurements can provide information about how MTX is being absorbed, retained, and metabolized by a patient, leading to better dosing by physicians and greater efficacy to the patient.

Medco Research Institute, a wholly owned subsidiary of Medco Health Solutions, a pharmaceutical benefits management company, will work with Medco clients to recruit patients for NIMBLE. Participants will have blood samples taken, which will then be submitted to Exagen for testing at its CLIA laboratory. Test results will be provided to Medo Research Institute and to the prescribing physician to make any necessary dosing changes.

Up to about 400 Medco members who are new to MTX therapy are expected to have Advise PG testing performed. Their test results will be compared with Medco members who did not receive Avise PG testing in order to determine the clinical utility and cost-effectiveness of the testing program.

Financial and other terms of the collaboration were not disclosed.

In a statement, Felix Frueh, president of Medco Research Institute, said that molecular tests such as Avise PG can help physicians make more precise treatment decisions.

"This is especially important when next-in-line therapy is a biologic medication that can cost a patient and payor significantly more, and may come with additional negative side effects," he said. "The findings we observe through the NIMBLE pilot will be an important step in understanding the value of testing like this and may bring us closer to making this testing standard practice for RA patients."

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