Drug used to treat rheumatoid arthritis could prevent disease onset

A rheumatoid arthritis drug used to ease symptoms such as pain and fatigue can also prevent the disease onset, according to new research.

The biologic drug abatacept is currently used as a second- or third-line treatment for people living with established rheumatoid arthritis. Now, new trial data, published in The Lancet, shows that year-long treatment with the biologic could halt the progression of the disease.

Rheumatoid arthritis affects half a million people in the UK

Currently, there are currently no drugs available that prevent rheumatoid arthritis – a disease which affects half a million people in the UK.

This type of arthritis develops when the body’s immune system attacks itself. This causes joint pain, swelling, and can lead to significant disability.

To test whether abatacept could prevent the onset of rheumatoid arthritis, researchers from King’s College recruited 213 at-risk individuals.

The participants were aged 18 or older, had inflammatory joint pain (but not swelling) and tested positive for serum antibodies to citrullinated protein antigens (ACPA).

Participants were randomly assigned to 125 mg abatacept subcutaneous injections weekly or placebo for 12 months, and then followed up for 12 months.

The primary endpoint was the time to development of clinical synovitis in three or more joints or rheumatoid arthritis according to national criteria.

‘Good news’ for patients at risk of rheumatoid arthritis

During the treatment period, seven (6%) of 110 participants in the abatacept group and 30 (29%) of 103 participants in the placebo group met the primary endpoint.

At 24 months, 27 (25%) of 110 participants in the abatacept group had progressed to rheumatoid arthritis, compared with 38 (37%) of 103 in the placebo group.

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.

Professor Andrew Cope, from King’s College London, said these results “could be good news for people at risk of arthritis”.

“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,” he said.

“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,” he added.

One year of treatment with abatacept costs around £10,000

The researchers say abatacept has an “acceptable safety profile”, with seven serious adverse events in the abatacept group and 11 in the placebo group.

Known side effects of abatacept include upper respiratory tract infections, dizziness, nausea and diarrhoea, but these are generally mild.

One year’s treatment with the biologic costs the NHS around £10,000 per patient, and Rheumatologist Professor Sir Ravinder N Maini FRS FMedSci FRCP, who was not involved in the research, says the study raises important questions around cost and efficacy in the long term.

He said: “Prevention of disease is of course a highly desirable goal in preventing the ravages of disabling RA, which is associated with a significant social and financial burden.

“Many further questions arise from this important study. For example, will this preventive approach be safe and cost effective if continued long term or can the selection of suitable populations be refined so that only those likely to benefit most are treated with a short course of treatment?”

Professor Cope says the research team are now carrying out further research to ensure that those at highest risk of developing rheumatoid arthritis can receive the drug.