How a Pharmacogenomics Test Helped Kelly Lasarow Find the Right Rheumatoid Arthritis Treatment

Find the Right Treatment for Rheumatoid Arthritis 

Q: Can you tell us a bit about yourself?

Kelly: I work in private banking at HSBC, but outside of that, my real passion is show jumping. Horses have been a huge part of my life for years.

Q: What health challenge were you facing?

Kelly: I was diagnosed with rheumatoid arthritis and prescribed methotrexate as the standard first-line treatment. But after months on it, I wasn’t seeing any real benefit. The pain and stiffness in my joints weren’t improving, and simple things like gripping the reins while riding became difficult. Everyday tasks, even just buttoning a shirt, were a struggle.

Q: What made you consider pharmacogenomic (PGx) testing?

Kelly: My husband, Avi, founded DNAfit, so I was already aware of how genetics can influence many aspects of daily life. After so much frustration with my treatment, I took a PGx test to see if my body was even processing methotrexate properly.

Q: What did the results reveal?

Kelly: The test showed that methotrexate wouldn’t be effective for me based on my genetics. That explained why I wasn’t seeing any improvement - it just wasn’t the right drug for me.

Q: What happened next?

Kelly: I switched to a biologic treatment, and it made a huge difference. I got the relief I had been waiting months for.

Q: What’s your takeaway from this experience?

Kelly: The NHS had essentially wasted time and money on a medication that was never going to work for me. But beyond that, my health suffered. If I had taken a PGx test earlier, I could have avoided months of pain and found the right treatment faster. Some people experience serious side effects from the wrong medication, luckily, for me, it was just wasted time. But time matters when you’re dealing with a progressive condition.

Q: Would you recommend PGx testing?

Kelly: Absolutely. It’s a game-changer. If you’re struggling with an autoimmune condition and medications that don’t seem to work, knowing how your body processes them could save you months or even years of trial and error.

Scientific Addendum: Why Pharmacogenomics Matters in Methotrexate Response

At AttoDiagnostics, our pharmacogenomic testing analyses key genetic markers that influence how individuals metabolise and respond to medications. One of the key pathways we examine for methotrexate efficacy is the MTHFR rs1801133 variant.

The Role of MTHFR in Methotrexate Metabolism

Methotrexate is commonly used to treat rheumatoid arthritis (RA) by inhibiting dihydrofolate reductase (DHFR), which affects folate metabolism and reduces inflammation. However, its effectiveness depends on how efficiently the body processes folate, which is largely influenced by the MTHFR (methylenetetrahydrofolate reductase) gene.

The rs1801133 variant (C677T) in the MTHFR gene affects the enzyme's ability to convert folate into its active form, 5-methyltetrahydrofolate (5-MTHF). Individuals with certain genetic variations,especially those with the TT genotype may have reduced enzyme activity, leading to lower folate availability. Since methotrexate works by interfering with folate metabolism, patients with these genetic variants may experience poor drug response or heightened side effects.

Why Did Methotrexate Fail for Kelly?

Kelly’s pharmacogenomic results indicated that methotrexate wouldn’t be effective for her due to her MTHFR variant, meaning her body was unable to process the drug as intended. Instead of suppressing inflammation, the medication was essentially ineffective, leading to a lack of symptom relief and progression of her RA.

This is a classic case of pharmacogenomic variability, what works for one patient may not work for another due to genetic differences. By identifying these genetic markers in advance, patients can avoid months of trial and error, ensuring they receive targeted, effective treatment from the start.

The Value of Pharmacogenomic Testing in Rheumatoid Arthritis

• Optimises treatment selection – Identifies whether methotrexate is likely to be effective or if alternative treatments, such as biologics, should be considered earlier.

• Reduces unnecessary side effects – Patients with certain MTHFR variants may be at greater risk of methotrexate-related side effects, such as fatigue, nausea, and mouth ulcers.

• Saves time and resources – Patients like Kelly can avoid months of ineffective treatment, and healthcare providers can allocate resources more efficiently.

Conclusion

Kelly’s case highlights the power of pharmacogenomics in personalised medicine. At AttoDiagnostics and AttoPGx, we analyse key genetic markers, such as MTHFR rs1801133, to ensure patients receive the most effective treatments for their unique genetic makeup. For individuals with rheumatoid arthritis or other conditions requiring long-term medication, PGx testing provides critical insights that can significantly improve treatment outcomes.

Shop All Pgx