Rheumatoid arthritis drug may actually prevent disease from starting for high-risk people

LONDON — There’s new hope for people who are susceptible to developing rheumatoid arthritis. Researchers at King’s College London have discovered that the drug abatacept (brand name Orencia), which is typically used to treat the condition, may also have the potential to prevent the onset of the disease in individuals considered to be at high risk.

Rheumatoid arthritis, a chronic inflammatory disease affecting over a million people in the United States, occurs when the body’s immune system erroneously targets its own joints. This results in pain, swelling, and a significant reduction in mobility and quality of life. Although it primarily strikes during middle age, the disease can afflict individuals of all ages. Despite extensive research, a cure or effective means of prevention has remained elusive — until now.

Orencia, which is administered through weekly injections or hospital infusions, has been an established treatment for individuals with advanced stages of rheumatoid arthritis. The King’s College London-led trial sought to explore whether early intervention with Orencia could stave off the disease in those showing early symptoms, such as joint pain without swelling.

The study involved 213 participants deemed at high risk of developing rheumatoid arthritis. These individuals were randomly assigned to receive either Orencia or a placebo weekly for a year. Following this period, the drug administration ceased, and participants were observed for an additional 12 months.

The results were striking. After the initial 12-month treatment phase, only six percent of those treated with Orencia progressed to full-blown arthritis, compared to 29 percent of those who received the placebo. Even after 24 months, the benefits of Orencia were evident, with 25 percent of its recipients developing rheumatoid arthritis versus 37 percent in the placebo group.

“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,” says study author Andrew Cope, a professor at King’s College London, in a university release.

“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.”

The trial also reported secondary benefits, including improved pain scores, enhanced quality of life, and reduced joint inflammation, as confirmed by ultrasound scans. These outcomes not only indicate a potential for preventing the disease but also suggest improvements in symptoms and overall well-being for those at risk.

The personal account of Philip Day, a participant in the trial, brings the study’s impact into sharp relief. Before joining the trial, Day’s joint pain severely limited his daily activities and hobbies, including playing soccer. The treatment transformed his life, eliminating his pain and allowing him to engage fully in physical activities with his son.

“The pain was unpredictable, it would show up 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 my future was pretty bleak if the disease progressed. I’d always wanted to be the kind of dad that played football (soccer) with his son and I knew the pain would stop me from realizing that dream,” explains Day.

“Enrolling in the trial was a no-brainer; it was a ray of hope at a dark time. Within a few months I had no more aches or pains and five years on I’d say I’ve been cured. Now, I can play football (soccer) with my 3-year-old son and have a normal life.”

The promising results come with considerations, though. The annual cost of Orencia treatment is over $12,500 per patient, and the drug is not without side effects, such as respiratory infections and nausea, though these are generally mild.

The study, funded by Bristol Myers Squibb, marks a critical step towards a preventive approach to rheumatoid arthritis, a goal long sought by the medical community.

“There are currently no drugs available that prevent this potentially crippling disease,” concludes Cope. “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.”

The study is published in the journal The Lancet.