Partners in precision: PrismRA now available via ‘thousands’ of Quest collection sites

Precision medicine in rheumatoid arthritis expanded in a small but key measure late last year, when Quest Diagnostics and Scipher Medicine announced a partnership to provide RNA extraction and sequencing services for the latter’s PrismRA test.

According to the multiyear collaboration deal, physicians can now order and receive results of Scipher’s PrismRA — a molecular diagnostic test that predicts TNF inhibitor response in patients with RA — via Quest’s system of collection locations and service centers. This includes specimen collection at approximately 7,300 Quest patient access points, with phlebotomists in physician offices and more than 2,100 patient service center locations. The partnership additionally includes courier logistics services, such as specimens transport between the Quest and Scipher laboratories and provider sites.

“Rheumatologists can order the test through Quest’s system, and it can be drawn at any one of the thousands of Quest collection sites throughout the country,” James D. Faix, MD, medical director of immunology at Quest Diagnostics, told Healio. “Quest will facilitate delivery of results to the physician.”

PrismRA assesses RNA transcripts in the blood and, along with anti-cyclic citrullinated peptide (anti-CCP) and certain clinical information, determines the likelihood of response to the therapy. In rheumatology, the tool represents one of the few examples of progress the specialty has made toward precision medicine access for patients.

Knowing which patients are likely to respond to TNF inhibitors can aid rheumatologists in streamlining the selection process of medications. In September, Scipher announced that Medicare will begin offering coverage for PrismRA, further expanding access.

Healio recently sat down with Faix to discuss the nature and logistics of the collaboration, the details of the PrismRA test and the importance of precision medicine in rheumatology.

Healio: What is the importance of predicting response to TNF inhibition for patients with RA?

Faix: It is well known that in a percentage of patients who initiate TNF inhibitors, these medications will not work, or the patient will develop resistance to them. This requires rheumatologists to take time to consider an alternative therapy. Studies have shown that if you can initiate a different therapy in these patients earlier, you can improve response and achieve outcomes like ACR50 much sooner. So, screening for non-response can be helpful for both rheumatologists and their patients.

Healio: How does this collaboration and development fit into the context of the move toward precision medicine across medical specialties?

Faix: Personalized medicine has been around for some time. Initially, the focus was largely on pharmacogenomics, understanding whether a patient is likely to respond to a drug and their ability to metabolize it. Recently, the focus has shifted to so-called companion diagnostics.

When some new drug is introduced to the market, there is a need to develop a lab test to screen people to see how they are likely to respond. Quest has been involved in companion diagnostics for some time, and we have been looking at molecular signatures of cancer cells and other approaches. We have a commitment to this part of precision medicine, and this collaboration with Scipher is a natural extension of that.

Healio: How will this collaboration impact the lives of practicing rheumatologists? What do they need to know?

Faix: The decision of how to use the results of the test is up to them. However, if they have a patient who has failed methotrexate and they are looking to either try a TNF inhibitor or use another mechanism of action, PrismRA is an easy way to get information regarding the likelihood of the patient responding. If that likelihood is low, the rheumatologist may consider a drug with a different mechanism of action such as a Janus kinase inhibitor. Quest wants to help Scipher get these insights to the rheumatologists.

Healio: How did this collaboration come about?

Faix: Quest has long been interested in collaborating with companies that complement our existing services for providers. We have a large portfolio of rheumatology testing, so this collaboration was an important addition to that. Of course, PrismRA is Scipher’s test, not a Quest innovation, but this collaboration enables Scipher to access more physicians given Quest’s national scale.

We initiated a program where we would be facilitating the testing and that evolved into a collaboration where we are doing the extraction and sequencing of the transcriptome and sending it to Scipher for them to apply their algorithm. Rheumatologists can order the test through Quest’s system and it can be drawn at any one of the thousands of Quest collection sites throughout the country. Quest will facilitate delivery of results to the physician. Scipher performs the PrismRA test and prepares the report at its CLIA laboratory in North Carolina.

Healio: When did the collaboration begin and how long will it continue?

Faix: It started in August of 2023 on the East Coast and then was rolled out to the rest of the country in September. This is a program we hope to continue. The plan is that this would be a long-term relationship.

Healio: It seems like quite a comprehensive set of logistics for specimen collection. How will those processes improve timely testing and treatment for patients?

Faix: The collection itself is pretty straightforward. It involves two tube types. One is a regular tube for CCP antibody. For RNA testing, there are also two PAXgene tubes that have a proprietary substance that stabilizes the intracellular RNA. There is nothing very complicated about the process at the draw site. As for the delivery, Quest has an extensive courier system. In fact, we have our own airline, Quest Air, as well as a courier fleet that allows us to deliver specimens all over the country.

Healio: To that point, do you foresee any potential issues with all of these logistics?

Faix: Quest Diagnostics is a leader in specimen logistics, as we serve thousands of patients every day with our logistics fleet and 2,000 patient service centers performing blood draws. As I said, Quest is only handling the pre- and post-analytical aspects. Any concerns patients or physicians have with the analytical aspects would be directed to Scipher.

For more information:

Scipher Press release:

https://www.sciphermedicine.com/quest-diagnostics-collaborate-scipher-medicine/