Stratified medicine in primary Sjögren’s syndrome

Concept

Primary Sjögren’s syndrome (PSS) is a chronic complex immune-mediated rheumatic disease with no effective treatment to date. PSS affects 0.05-0.1% of the adults. A key barrier to therapeutic development is the marked heterogeneity in clinical manifestations and pathobiological profiles among PSS patients. We have recently described a strategy to stratify PSS patients into four subtypes with distinct clinical phenotypes and transcriptomic signatures.

Facts and figures

Project lead
W-F Ng
Newcastle University
Wan-Fai.Ng@ncl.ac.uk
FOREUM research grant: € 600.000
2018 - 2021

Meet the team

W-F Ng
Newcastle University
D Lendrem
Newcastle University
J-E Gottenberg
Strasbourg University
R Seror
Université Paris Sud
V Devauchelle-Pensec
Brest University
A Saraux
Brest University
S Bowman
University of Birmingham
F Barone
University of Birmingham
B Fisher
University of Birmingham
G Nordmark
Uppsala University
U Landegren
Uppsala University
R Omdal
Stavanger University Hospital
M Bombardieri
Queen Mary University London

Objectives

The proposal aims to further characterise the clinical significance and the underpinning pathotypes of 4 PSS subtypes. The specific objectives are:

1. To understand the natural history of the different PSS subtypes.

2. To validate the transcriptomic signatures of the PSS subtypes and re-calibrate (if necessary) for non-UK cohorts.

3. To further characterise the underpinning pathobiological profiles of the four PSS subtypes

4. To explore whether the four subtypes respond differently to treatments by reanalysing data from two clinical trials (JOQUER (hydroxychloroquine) and TRACTISS (Rituximab)

Patient voice

We formed a patient advisory board – comprising 7 patient research partners from 4 participating countries - to advise on what information to collect to best describe the burden that PSS brings to their daily lives. The health economist Dr Peter McMeekin joined us to facilitate group discussion in developing the pro-forma for data collection. We have invited 3 patient research partners to join our steering committee to provide guidance and oversight of the whole proposal.

Interim results

  • Biological differences between the four key PSS subtypes confirmed in the French and Scandinavian cohorts.
  • We have established these PSS subtypes are relatively stable over time.  
  • Transcriptional differences between the PSS subtypes confirmed.
  • Patient advisory board established and patient-driven pro-forma for health outcome data in development.
  • Data from historical clinical trials collated: analysis in progress.

Publications

  • Jessica R Tarn, Nadia Howard-Tripp, Dennis W Lendrem, Xavier Mariette, Alain Saraux, Valerie Devauchelle-Pensec, Raphaele Seror, Andrew J Skelton, Katherine James, Peter McMeekin, Shereen Al-Ali, Katie L Hackett, B Clare Lendrem, Ben Hargreaves, John Casement, Sheryl Mitchell, Simon J Bowman, Elizabeth Price, Colin T Pease, Paul Emery, Peter Lanyon, John Hunter, Monica Gupta, Michele Bombardieri, Nurhan Sutcliffe, Costantino Pitzalis, John McLaren, Annie Cooper, Marian Regan, Ian Giles, David Isenberg, Vadivelu Saravanan, David Coady, Bhaskar Dasgupta, Neil McHugh, Steven Young-Min, Robert Moots, Nagui Gendi, Mohammed Akil, Bridget Griffiths , Svein J A Johnsen, Katrine B Norheim, Roald Omdal, Deborah Stocken, Colin Everett, Catherine Fernandez on behalf of Leeds CTRU, John D Isaacs,
    Jacques-Eric Gottenberg on behalf of the French ASSESS cohort, Wan-Fai Ng on behalf of the UK Primary Sjögren’s. Syndrome RegistrySymptom-based stratification of patients with primary Sjögren's syndrome: multi-dimensional characterisation of international observational cohorts and reanalyses of randomised clinical trials. Lancet Rheumatol 2019;
    1: e85–94.
    Read more
    Video abstract