Clinical trial shows rheumatoid arthritis drug could prevent disease

A drug used to treat rheumatoid arthritis could also prevent the disease in people deemed at risk. Results of a phase 2b clinical trial, published today in The Lancet by researchers led by King’s College London are giving hope to arthritis sufferers after the biologic drug abatacept was shown to reduce the progression of this distressing 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 often begins in middle age, but much younger age groups can be affected and, so far, there is no treatment or prevention.

Abatacept is currently used as an effective second- or third-line treatment for people living with established rheumatoid arthritis, and is administered as weekly injections at home or in hospital via an infusion.

Researchers at King’s College London recruited 213 patients at high risk of developing the disease to understand whether a year’s treatment with the biologic 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 discontinued and study participants were followed for an additional 12 months.

After twelve months of treatment, 6% of patients treated with abatacept had developed arthritis, compared to 29% in the placebo arm. After 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 treatment licensed for use in treating rheumatoid arthritis established rheumatoid arthritis is also effective in preventing the onset of the disease in people with These early results could be good news for people at risk of arthritis, as we show that the drug not only prevents the onset of the disease during the treatment phase, but can also relieve symptoms such as pain and fatigue. It 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 results of the trial showed that abatacept was associated with improvements in pain scores, measures of function and quality of life, as well as lower scores of mucosal inflammation of the joints detectable by ultrasound.

Philip Day, a 35-year-old software engineer and founder of FootballMatcher from Eltham, was at high risk of rheumatoid arthritis. A football fan, Philip’s joint pain put him off playing and affected his everyday life. He was enrolled in the trial in 2018, at age 30, and was prescribed abatacept.

He said: “The pain became so bad that I stopped going to football, became lazier and felt worse and worse physically and mentally. The pain was unpredictable, it would appear in my knees one day, my elbows the next, and then my wrists or even my neck. At the time, my wife and I wanted to have children and I realized that my future was quite bleak if the disease progressed. I always wanted to be the kind of dad who played soccer with his son and I. I knew the pain would keep me from achieving that dream.

“Signing up for the trial was a no-brainer; it was a beacon of hope in a dark time. Within a few months I was pain free and five years later I would say I was cured. I can play football with my three-year-old son and live a normal life.”

A year’s course of abatacept costs the NHS around £10,000 per patient and is not without risk. Side effects include upper respiratory infections, dizziness, nausea, and diarrhea, but are usually mild.

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

Professor Sir Ravinder N Maini FRS FMedSci FRCP, rheumatologist, who was not involved in the research, said: “Professor Cope and his colleagues at King’s College London, in collaboration with researchers from the UK and the -Bas, have published the results of an exciting clinical trial. In The Lancetwhich demonstrates that it is now possible to prevent the onset of RA, a disease which remains incurable despite the great progress made in its treatment in the recent past.

“The results clearly show that during the treatment period, almost all individuals receiving the biologic drug did not experience any symptoms or signs of RA compared to the control population among many more developed RA. In the follow-up period of a year without treatment, it is interesting to note that some seemed to go into remission.

“Disease prevention is, of course, a highly desirable goal for preventing the ravages of disabling RA, which is associated with significant social and financial burden. Many other questions arise from this important study. For example, this approach Will preventive treatment be safe and cost-effective if continued long-term or can the selection of appropriate populations be refined so that only those likely to benefit most are treated with short-term treatment?