Periodic Reporting for period 2 - SQUEEZE (Maximising Impact of Prescription Drugs in Rheumatoid Arthritis)
Période du rapport: 2024-06-01 au 2025-11-30
There is a significant unmet need for better selection of treatments for patients with rheumatoid arthritis (RA). Despite having many treatment options, therapies are often not very effective in helping the patients achieve a long-term symptom-free state (remission). We need improved methods to determine which patients will respond to specific medications, as current approaches aren’t personalized enough as well as better tools, like biomarkers, to help tailor treatments to individual needs. In addition, shared-decision making processes should be advanced in routine clinical care to guarantee satisfaction with disease management and thereby increasing adherence of patients to medication.
The SQUEEZE project is focused on using advanced biomarkers to make treatment of RA more personalized, effective, and safe for patients. It seeks to personalize medication choices, ensuring that patients receive the most effective drugs for their condition and thereby reducing the burden of active disease as well as healthcare and societal costs. Additionally, the program aims to enhance the safety of treatments by monitoring key indicators for better medication management. Finally, SQUEEZE plans to create collaborative care models that involve patients and healthcare providers in decision-making and will collaborate with other initiatives to sustainably improve the overall RA treatment landscape.
The SQUEEZE project is focused on using advanced biomarkers to make treatment of RA more personalized, effective, and safe for patients. It seeks to personalize medication choices, ensuring that patients receive the most effective drugs for their condition and thereby reducing the burden of active disease as well as healthcare and societal costs. Additionally, the program aims to enhance the safety of treatments by monitoring key indicators for better medication management. Finally, SQUEEZE plans to create collaborative care models that involve patients and healthcare providers in decision-making and will collaborate with other initiatives to sustainably improve the overall RA treatment landscape.
Over the past three years, the SQUEEZE project has made important progress towards its overall objectives.
First, the SQUEEZE consortium analysed large amounts of existing clinical data from people living with RA across multiple European countries. These data were carefully collected, cleaned, and harmonised to allow meaningful comparisons between patients. The analyses focused in particular on responses to methotrexate (MTX), which is the most commonly used first-line treatment for RA. The project identified different patterns of disease and patient characteristics that are linked to treatment response and long-term outcomes.
In parallel, SQUEEZE launched three multi-center clinical studies that are currently recruiting patients.
These studies aim to:
1. better classify patients based on their biological characteristics in order to match them with the most suitable treatment;
2. identify the most effective dose and route of administration of MTX; and
3. use laboratory measurements of drug levels to guide treatment adjustments and maintain good disease control over time.
A key area of innovation in SQUEEZE is the investigation of biomarkers to monitor immune system activity. One subproject is studying whether torque teno virus (TTV) levels in the blood can reflect how strongly the immune system is suppressed by RA treatments and if changes in levels relate to treatment response and disease activity.
SQUEEZE is testing and validated new laboratory methods to measure drug levels and treatment adherence, especially for MTX and biological DMARD Adalimumab. These methods help distinguish between patients who do have sufficient levels of medication and those who would benefit from dose adjustments or do not take the medication as prescribed. This should improve overall treatment response and long-term outcomes.
In addition, the SQUEEZE team developed and strengthened a digital care model that helps healthcare teams better support patients in taking their treatments safely and effectively. The model uses patient-reported questionnaires to identify risks, group patients according to their needs, and provide personalized support to improve medication adherence. Key assessment tools were finalized and prepared for use in multiple studies, allowing consistent and reliable monitoring of how well patients follow their treatments in real-world healthcare settings. This helps improve treatment effectiveness and patient safety.
Finally, the SQUEEZE consortium invested strongly in training and professional development. Healthcare professionals and early-career researchers received practical, hands-on training to support the use of the SQUEEZE Care Model in everyday clinical practice. The project also offered workshops, webinars, online courses, exchange visits, and research training, helping participants build skills and experience. Through conference participation, patient engagement activities, and communication initiatives such as videos and social media, SQUEEZE helped researchers and clinicians share their work, connect with patients and stakeholders, and increase their visibility within the international community.
Together, these achievements provide a strong foundation for the next phase of the SQUEEZE project.
First, the SQUEEZE consortium analysed large amounts of existing clinical data from people living with RA across multiple European countries. These data were carefully collected, cleaned, and harmonised to allow meaningful comparisons between patients. The analyses focused in particular on responses to methotrexate (MTX), which is the most commonly used first-line treatment for RA. The project identified different patterns of disease and patient characteristics that are linked to treatment response and long-term outcomes.
In parallel, SQUEEZE launched three multi-center clinical studies that are currently recruiting patients.
These studies aim to:
1. better classify patients based on their biological characteristics in order to match them with the most suitable treatment;
2. identify the most effective dose and route of administration of MTX; and
3. use laboratory measurements of drug levels to guide treatment adjustments and maintain good disease control over time.
A key area of innovation in SQUEEZE is the investigation of biomarkers to monitor immune system activity. One subproject is studying whether torque teno virus (TTV) levels in the blood can reflect how strongly the immune system is suppressed by RA treatments and if changes in levels relate to treatment response and disease activity.
SQUEEZE is testing and validated new laboratory methods to measure drug levels and treatment adherence, especially for MTX and biological DMARD Adalimumab. These methods help distinguish between patients who do have sufficient levels of medication and those who would benefit from dose adjustments or do not take the medication as prescribed. This should improve overall treatment response and long-term outcomes.
In addition, the SQUEEZE team developed and strengthened a digital care model that helps healthcare teams better support patients in taking their treatments safely and effectively. The model uses patient-reported questionnaires to identify risks, group patients according to their needs, and provide personalized support to improve medication adherence. Key assessment tools were finalized and prepared for use in multiple studies, allowing consistent and reliable monitoring of how well patients follow their treatments in real-world healthcare settings. This helps improve treatment effectiveness and patient safety.
Finally, the SQUEEZE consortium invested strongly in training and professional development. Healthcare professionals and early-career researchers received practical, hands-on training to support the use of the SQUEEZE Care Model in everyday clinical practice. The project also offered workshops, webinars, online courses, exchange visits, and research training, helping participants build skills and experience. Through conference participation, patient engagement activities, and communication initiatives such as videos and social media, SQUEEZE helped researchers and clinicians share their work, connect with patients and stakeholders, and increase their visibility within the international community.
Together, these achievements provide a strong foundation for the next phase of the SQUEEZE project.
SQUEEZE went beyond current approaches in rheumatoid arthritis care by developing new ways to predict, monitor, and improve how patients respond to existing treatments. It identified and validated innovative biological markers, including a virus-based marker in the blood that reflects how strongly the immune system is affected by treatment and can predict whether a therapy is likely to work early on. SQUEEZE also combined detailed clinical, laboratory, and molecular data from patients across Europe into a shared, secure data platform, allowing researchers to understand why treatments work better for some patients than others. Importantly, the project links deep tissue and blood analyses directly to how patients respond to specific drugs, helping to move toward choosing the right medicine for the right patient.
Overall, the evidence suggests that medication adherence in European RA patients remains suboptimal and insufficiently understood from a socio-economic perspective. The strong reliance on self-reported adherence measures and the inconsistent associations observed for traditional socio-demographic variables indicate that current research may be missing key contextual drivers of adherence. In contrast, the more consistent impact of patients’ beliefs about medicines points to the importance of psychosocial and health-system–related factors, underscoring the need for more holistic, standardized, and context-sensitive approaches to studying and addressing adherence across diverse European healthcare settings.
In addition, SQUEEZE improved measuring by introducing novel blood tests, non-invasive sweat analysis, and digital tools. This made it possible to separate true drug failure from non-adherence. SQUEEZE also developed digital care tools that help healthcare teams identify patient risks early and provide tailored support, while considering social and economic factors that influence treatment success. Together, these advances move rheumatoid arthritis care beyond one-size-fits-all treatment toward more personalized, safer, and more effective care in everyday clinical practice.
Overall, the evidence suggests that medication adherence in European RA patients remains suboptimal and insufficiently understood from a socio-economic perspective. The strong reliance on self-reported adherence measures and the inconsistent associations observed for traditional socio-demographic variables indicate that current research may be missing key contextual drivers of adherence. In contrast, the more consistent impact of patients’ beliefs about medicines points to the importance of psychosocial and health-system–related factors, underscoring the need for more holistic, standardized, and context-sensitive approaches to studying and addressing adherence across diverse European healthcare settings.
In addition, SQUEEZE improved measuring by introducing novel blood tests, non-invasive sweat analysis, and digital tools. This made it possible to separate true drug failure from non-adherence. SQUEEZE also developed digital care tools that help healthcare teams identify patient risks early and provide tailored support, while considering social and economic factors that influence treatment success. Together, these advances move rheumatoid arthritis care beyond one-size-fits-all treatment toward more personalized, safer, and more effective care in everyday clinical practice.