类风湿关节炎 (RA) 患者对传统合成缓解病情抗风湿药物 (csDMARD) 反应不足，因此临床指南对治疗选择几乎没有提供指导。分子特征反应分类器 (MSRC) 经验证可预测肿瘤坏死因子抑制剂 (TNFi) 的反应不足。评估了 MSRC 结果对生物制剂和靶向合成缓解病情抗风湿药物 (b/tsDMARD) 选择的决策影响。这是对 AIMS 的分析，AIMS 是使用 MSRC 测试的 RA 患者的纵向前瞻性数据库。本研究通过调查医生评估了 MSRC 测试后 b/tsDMARD 类别的选择、b/tsDMARD 处方与 MSRC 结果一致的比例，以及医生利用 MSRC 结果进行决策的百分比。在 1018 名参与者中，70.7%（720/ 1018) 在收到 MSRC 结果后选择了治疗。在这个获悉 MSRC 的队列中，75.6% (544/720) 的患者接受了与 MSRC 结果一致的 b/tsDMARD，84.6% (609/720) 的提供者报告使用 MSRC 结果来指导治疗选择。未将治疗选择与总队列中的 MSRC 结果保持一致的最常见原因（8.2%，59/720）是健康保险覆盖问题。这项研究表明，风湿病学家报告使用 MSRC 测试来指导患有以下疾病的患者选择 b/tsDMARD RA。根据医生的自我报告，在大多数情况下，MSRC 测试结果似乎会影响临床决策。更广泛地采用 MSRC 等精准医疗工具可以支持风湿病学家和患者共同努力，以实现 RA 的最佳结果。© 2023。作者。

Clinical guidelines offer little guidance for treatment selection following inadequate response to conventional synthetic disease-modifying antirheumatic drug (csDMARD) in rheumatoid arthritis (RA). A molecular signature response classifier (MSRC) was validated to predict tumor necrosis factor inhibitor (TNFi) inadequate response. The decision impact of MSRC results on biologic and targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) selection was evaluated.This is an analysis of AIMS, a longitudinal, prospective database of patients with RA tested using the MSRC. This study assessed selection of b/tsDMARDs class after MSRC testing by surveying physicians, the rate of b/tsDMARD prescriptions aligning with MSRC results, and the percentage of physicians utilizing MSRC results for decision-making.Of 1018 participants, 70.7% (720/1018) had treatment selected after receiving MSRC results. In this MSRC-informed cohort, 75.6% (544/720) of patients received a b/tsDMARD aligned with MSRC results, and 84.6% (609/720) of providers reported using MSRC results to guide treatment selection. The most prevalent reason reported (8.2%, 59/720) for not aligning treatment selection with MSRC results from the total cohort was health insurance coverage issues.This study showed that rheumatologists reported using the MSRC test to guide b/tsDMARD selection for patients with RA. In most cases, MSRC test results appeared to influence clinical decision-making according to physician self-report. Wider adoption of precision medicine tools like the MSRC could support rheumatologists and patients in working together to achieve optimal outcomes for RA.© 2023. The Author(s).