Drug slashes risk of developing rheumatoid arthritis by 60 percent, study suggests
An already approved drug has shown promise in preventing rheumatoid arthritis in people with a pre-existing condition that progresses into RA in more than half of cases.
Palindromic rheumatism (PR) is a rare form of inflammatory arthritis that typically strikes people in their 40s, causing sudden, recurrent attacks of joint pain and swelling that typically last hours or days before resolving without causing permanent joint damage.
But for the roughly 16,000 Americans with the little-understood condition, it’s a warning sign, as up to 60 percent will eventually go on to develop rheumatoid arthritis (RA), a chronic autoimmune disease that causes lifelong joint pain, stiffness and disability.
However, a recent Spanish clinical trial studying the drug abatacept, sold under the brand name Orencia, found it could cut the risk of progression from palindromic rheumatism to RA by more than half compared to a common treatment – from 50 percent to about 21 percent.
Additionally, among those who went on to develop RA, abatacept, which dampens the overactive immune response that drives the disease, delayed onset nearly four times longer than hydroxychloroquine, an antimalarial medication often used to manage PR symptoms.
Beyond delaying and preventing RA, abatacept also reduced symptom severity.
Patients on the experimental drug reported less intense joint attacks and were more than twice as likely to have no more than one attack over a 12-month period compared to those on hydroxychloroquine.
The study builds on a growing body of research suggesting that intervening early in the ‘pre-clinical’ phase of RA – before permanent joint damage occurs – could change the course of the disease.
Palindromic rheumatism typically strikes in the 40s with sudden, fleeting joint attacks that leave no permanent damage. But for the roughly 16,000 Americans with the condition, up to 60 percent will eventually develop rheumatoid arthritis, a chronic autoimmune disease (stock)
The trial, published in Nature Medicine, was a randomized study conducted across 14 rheumatology centers in Spain.
Researchers enrolled 73 adults who had been diagnosed with palindromic rheumatism for between three months and three years, and who tested positive for two key antibodies, RF and ACPA, that signal a high risk of developing rheumatoid arthritis.
Participants were randomly assigned to receive either the injectable drug abatacept weekly for the first year and every two weeks for the second year, or hydroxychloroquine in pill form daily for the full two years.
Patients were checked every three months. The main goal was to see how many developed RA over the two-year period.
Researchers also tracked how often joint attacks occurred, how severe they were, how long they lasted, how many patients achieved remission, and any side effects.
Blood samples were also analyzed for any changes in autoantibody levels.
Both drugs were generally well tolerated, with no deaths and only one patient stopping abatacept due to mild side effects.
Over two years, just 20.6 percent of patients treated with abatacept developed RA, compared to 50 percent of those taking hydroxychloroquine.
Over two years, just 20.6 percent of patients on abatacept developed RA versus 50 percent on hydroxychloroquine — a 29.4 percent absolute risk reduction. The results held even when counting dropouts as failures (the pair of bars on the left), the study’s primary analysis, and when analyzing only those who completed the trial (the pair of bars on the right)
Abatacept did not just prevent RA. It also made living with palindromic rheumatism more bearable.
Patients on abatacept had milder attacks and were more than twice as likely to reach remission.
Fifty-six percent of those on abatacept experienced no more than one flare-up over a year, meaning they had either no attacks at all or just a single episode.
Meanwhile, just 23 percent of those on hydroxychloroquine could say the same, with 77 percent suffering more than one flare-up during that same period.
A five-year follow-up of the trial participants is currently underway to determine whether the protective effects of abatacept persist after treatment is stopped.
The new findings echo earlier research. Two previous trials found that abatacept could delay or prevent RA in people at high risk.
In one trial, only six percent of abatacept patients developed RA during the first year, compared to 29 percent on placebo.
In the other, just eight percent on abatacept developed RA over six months, versus 35 percent on placebo.
But in those earlier studies, once treatment stopped, RA rates rebounded. In this new trial, patients stayed on abatacept for a full two years and the results suggest that staying on the drug longer may keep RA at bay for longer.
