In a groundbreaking Phase 2b clinical trial led by researchers at King’s College London and published in The Lancet, a biologic drug known as abatacept, commonly employed to manage rheumatoid arthritis, has demonstrated its potential to prevent the onset of the disease in individuals deemed to be at high risk.

Rheumatoid arthritis, a chronic inflammatory condition affecting around half a million people in the UK, is characterized by the immune system mistakenly attacking the body’s joints, resulting in joint pain, swelling, and significant disability. While the disease typically emerges in middle age, it can affect younger age groups, and as of now, there is no definitive cure or preventive measure.

Abatacept, presently utilized as a second or third-line treatment for established rheumatoid arthritis, is administered through weekly injections at home or hospital drips. The researchers from King’s College London recruited 213 high-risk patients, aged 18 and above, exhibiting early symptoms such as joint pain without swelling. Half of the participants received abatacept, while the other half were given a placebo every week for a year. Following this treatment phase, the study participants were monitored for an additional 12 months.

After a year of treatment, only 6% of patients treated with abatacept had developed arthritis, compared to a substantial 29% in the placebo group. This significant difference persisted at the 24-month mark, with 25% progressing to rheumatoid arthritis in the abatacept group, as opposed to 37% in the placebo group.

Professor Andrew Cope from King’s College London highlighted the trial’s significance as the largest rheumatoid arthritis prevention study to date, indicating that the therapy licensed for treating established rheumatoid arthritis has proven effective in preventing its onset in high-risk individuals. Notably, the results suggest not only prevention during treatment but also relief from symptoms like pain and fatigue.

Philip Day, a 35-year-old software engineer enrolled in the trial, expressed his transformative experience with abatacept, emphasizing the relief from joint pain and the subsequent ability to lead a normal, active life.

While acknowledging the cost of one year’s treatment with abatacept at around £10,000 per patient and associated mild side effects, including upper respiratory tract infections, dizziness, nausea, and diarrhea, Professor Cope underscored the absence of available drugs to prevent this potentially debilitating disease. The next steps involve delving deeper into understanding at-risk populations to ensure that those with the highest risk receive the drug.

Rheumatologist Professor Sir Ravinder N Maini FRS FMedSci FRCP, not directly involved in the research, lauded the study’s significance, posing questions about the long-term safety and cost-effectiveness of the preventive approach and refining population selection for treatment benefits.


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