Rheumatoid Arthritis Drug Could Prevent Disease

A drug used to treat rheumatoid arthritis could also prevent the disease in individuals deemed to be at risk. Results from a Phase 2b clinical trial, published in The Lancet by researchers led by King’s College London, provides hope for arthritis sufferers after it was shown that the biologic drug abatacept reduces progression to this agonising chronic inflammatory disease.

Rheumatoid arthritis affects half a million people in the UK and develops when the body’s immune system attacks itself, causing joint pain, swelling and significant disability. The disease most commonly begins in middle age, but much younger age groups can be afflicted, and until now there is no cure or prevention.

Abatacept is currently used as an effective second or third line treatment for people living with established rheumatoid arthritis and is given by weekly injections at home or in hospital via a drip.

Researchers from King’s College London recruited 213 patients at high risk of the disease to understand whether a year-long treatment of the biologic drug could be used to prevent progression to rheumatoid arthritis.

They recruited men and women over the age of 18 with early symptoms such as joint pain but no joint swelling, and treated half with the drug and half with a placebo every week for a year. The study drug was then stopped, and study participants monitored for a further 12 months.

After twelve months of treatment, 6% of patients treated with abatacept had developed arthritis compared to 29% in the placebo arm. By 24 months, the differences were still significant, with a total of 25% progressing to rheumatoid arthritis in the abatacept arm compared to 37% in the placebo arm.

Professor Andrew Cope, from King’s College London, said: “This is the largest rheumatoid arthritis prevention trial to date and the first to show that a therapy licensed for use in treating established rheumatoid arthritis is also effective in preventing the onset of disease in people at risk. These initial results could be good news for people at risk of arthritis as we show that the drug not only prevents disease onset during the treatment phase but can also ease symptoms such as pain and fatigue. This is also promising news for the NHS as the disease affects people as they age and will become more expensive to treat with a growing aging population.”

Secondary outcomes for the trial showed that abatacept was associated with improvements in pain scores, function and quality of life measurements, as well as lower scores of inflammation of the lining of joints detectable by ultrasound scan.

One year’s treatment with abatacept costs the NHS about £10,000 per patient and is not without risk. Side effects include upper respiratory tract infections, dizziness, nausea and diarrhea, but these are generally mild.

Professor Cope added: “There are currently no drugs available that prevent this potentially crippling disease. Our next steps are to understand people at risk in more detail so that we can be absolutely sure that those at highest risk of developing rheumatoid arthritis receive the drug.”

Sources:

Andrew P Cope, Marianna Jasenecova, Joana C Vasconcelos, Andrew Filer, Karim Raza, Sumera Qureshi, Maria Antonietta D’Agostino, Iain B McInnes, John D Isaacs, Arthur G Pratt, Benjamin A Fisher, Christopher D Buckley, Paul Emery, Pauline Ho, Maya H Buch, Coziana Ciurtin, Dirkjan van Schaardenburg, Thomas Huizinga, René Toes, Evangelos Georgiou, Joanna Kelly, Caroline Murphy, A Toby Prevost, Sam Norton, Heidi Lempp, Maria Opena, Sujith Subesinghe, Toby Garrood, Bina Menon, Nora Ng, Karen Douglas, Christos Koutsianas, Faye Cooles, Marie Falahee, Irene Echavez-Naguicnic, Anurag Bharadwaj, Michael Villaruel, Ira Pande, David Collins, Suzannah Pegler, Sabrina Raizada, Stefan Siebert, George Fragoulis, Jesusa Guinto, James Galloway, Andrew Rutherford, Theresa Barnes, Helen Jeffrey, Yusuf Patel, Michael Batley, Brendan O’Reilly, Srivinisan Venkatachalam, Thomas Sheeran, Claire Gorman, Piero Reynolds, Asad Khan, Nicola Gullick, Siwalik Banerjee, Kulveer Mankia, Deepak Jordan, Jane Rowlands, Mirian Starmans-Kool, James Taylor, Pradip Nandi, Ilfita Sahbudin, Mark Maybury, Samantha Hider, Ann Barcroft, Jeremy McNally, Jo Kitchen, Muhammad Nisar, Vanessa Quick. Abatacept in individuals at high risk of rheumatoid arthritis (APIPPRA): a randomised, double-blind, multicentre, parallel, placebo-controlled, phase 2b clinical trial. The Lancet, 2024; DOI: 10.1016/S0140-6736(23)02649-1

King’s College London. (2024, February 13). Clinical trial shows rheumatoid arthritis drug could prevent disease. ScienceDaily. Retrieved February 19, 2024 from www.sciencedaily.com/releases/2024/02/240213190512.htm

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