Rheumatoid arthritis drugs may prevent disease

Abatacept tested in high-risk individuals for rheumatoid arthritis in phase 2b trial.

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A drug used to treat rheumatoid arthritis might also stop the disease from developing in people who are at risk. Rheumatoid arthritis is a condition that causes pain and swelling in the joints, especially in the knees.

A new study published in The Lancet by King’s College London researchers gives hope to people with arthritis. They found that a drug called abatacept can reduce the chances of getting this painful disease.

Rheumatoid arthritis affects around half a million people in the UK. It happens when the body’s immune system attacks the joints, leading to pain, swelling, and disability. While it usually starts in middle age, younger people can also get it. Until now, there hasn’t been a cure or a way to prevent it.

After a year of treatment, only 6% of patients on abatacept had arthritis compared to 29% on placebo. By two years, 25% on abatacept and 37% on placebo had developed rheumatoid arthritis.

This study is the biggest one yet on preventing rheumatoid arthritis. It’s the first to show that a drug already used to treat arthritis can also stop it from starting in at-risk people. These early results are good news for those at risk, as the drug prevents the disease and helps with symptoms like pain and fatigue. It’s also good for the NHS, as arthritis affects more people as they age, and treating it gets more expensive.

Professor Andrew Cope, a rheumatology expert, said, “The trial also found that abatacept improved pain, function, and quality of life, and reduced joint inflammation seen on ultrasound.”

Philip Day, a 35-year-old software engineer and founder of Football Matcher from Eltham, had joint pain that made it hard for him to play football and do everyday activities. He joined the trial in 2018, when he was 30, and was given abatacept.

Philip said, “The pain was so bad that I stopped playing football, and I felt worse physically and mentally. It was unpredictable – one day, my knees hurt; the next day, my elbows, then my wrists or neck. My wife and I wanted to have children, and I knew the pain would stop me from being the dad I wanted to be.”

“Joining the trial was an easy decision; it gave me hope. Within a few months, the pain was gone, and after five years, I was cured. Now, I can play football with my three-year-old son and live a normal life.”

Abatacept treatment for one year costs the NHS around £10,000 per patient. It carries some risks, such as mild side effects like upper respiratory infections, dizziness, nausea, and diarrhea.

Professor Cope said, “Right now, there are no drugs that can stop this serious disease. Our next goal is to study those at risk more closely to ensure those most likely to get rheumatoid arthritis get the treatment they need.”

The study shows that abatacept could help stop rheumatoid arthritis in people likely to get it. However, more research is needed to understand who is at risk and how to treat them effectively.

Journal reference:

  1. Andrew P Cope, Marianna Jasenecova, et al., Abatacept in individuals at high risk of rheumatoid arthritis (APIPPRA): a randomised, double-blind, multicentre, parallel, placebo-controlled, phase 2b clinical trial. The Lancet. DOI: 10.1016/S0140-6736(23)02649-1.
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