- A study has found that the drug abatacept could help prevent rheumatoid arthritis.
- It also appeared to improve pain, inflammation, function, and quality of life.
- It may work for this purpose because it targets immune reactions early in the process.
- Abatacept is currently only used to treat established rheumatoid arthritis.
- Experts say this could change how rheumatoid arthritis is managed.
A new study published in The Lancet indicates that the rheumatoid arthritis drug abatacept (brand name Orencia) could also be useful in preventing the disease.
Francisco Contreras, MD — Director, President, and Chairman of Oasis of Hope Medical Institute, who was not involved in the study — describes rheumatoid arthritis (RA) as being a chronic autoimmune condition with symptoms such as joint inflammation, swelling, pain, and stiffness.
“This inflammatory response, driven by the body’s immune system, can gradually result in damage to the joints and subsequent limitations in mobility and function over time,” he explained.
Abatacept is a biologic medication used to reduce the symptoms of adult rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, and psoriatic arthritis, according to Bristol Meyers Squibb, the manufacturer of Orencia.
The study’s authors note that abatacept is currently used as a second or third-line treatment for established rheumatoid arthritis.
It is administered weekly, either at home via injection or in a hospital via an intravenous drip.
Contreras said that if abatacept can also play a role in preventing rheumatoid arthritis, this could have significant implications.
“While conventional approaches to RA management primarily focus on symptom control,” he stated, “the potential preventive application of abatacept represents a paradigm shift in disease management strategies.”
Abatacept is a promising rheumatoid arthritis preventative
To study the drug’s ability to prevent rheumatoid arthritis, a team of researchers from King’s College London recruited 213 at-risk patients.
The study participants were adult men and women with early disease symptoms, such as joint pain without swelling.
Half of the patients were given treatment with abatacept for a year, while the other half received an inactive placebo.
Drug treatment was then ceased, but monitoring continued for an additional year.
The researchers found that only 6% of people treated with abatecept went on to develop arthritis after one year. This was in comparison to 29% of those given the placebo who developed the disease.
Even at the two-year mark, there was still a significant difference between the two groups, with 25% of drug-treated patients developing RA versus 37% in the placebo group.
It was also found that abatacept improved pain scores, function, and quality of life in people who received it preventatively.
Additionally, these people had lower scores for inflammation in their joint linings.
How abatecept might help prevent rheumatoid arthritis
Ani Rostomyan, PharmD, a clinical pharmacist practicing in the area of Diabetes and Genomics and Functional Medicine, said that consensus guidelines from the American College of Rheumatology and the European Alliance of Associations for Rheumatology currently advise using abatecept in people who already have established rheumatoid arthritis.
The rationale for the study was “if the pre-clinical phase of RA could be accurately defined, targeting therapy to those at highest risk of developing the more severe form of disease would possibly prevent or at least delay the onset of the disease,” Rostomyan explained.
Abatacept was chosen for the study because it can target immune reactions early in the process that can lead to the inflammation associated with rheumatoid arthritis.
This drug “is a fusion protein, composed of the Fc region of the immunoglobulin IgG1 fused to the extracellular domain of cytotoxic T-lymphocyte antigen 4 (CTLA-4),” she explained, adding that “it interrupts interaction between T-cells and antigen-presenting cells, weakening the co-stimulatory signals required for T-cell activation, differentiation, and effector responses, thereby resulting in downstream immunomodulatory effects on other inflammatory cells of the immune system.”
Rostomyan went on to say that using abatacept for this application is promising. However, in her opinion, given the state of healthcare coverage in the United States, it is unlikely to be given approval by health plans as a preventive medication.
She did note, though, that further studies into the drug could alter this assessment.
Takeaway
A new study has found that the rheumatoid arthritis medication abatacept (brand name Orencia) might additionally have applications as a preventive for the disease.
It also appears to help with symptoms such as pain, function, inflammation, and quality of life.
The reason it might work to prevent the development of rheumatoid arthritis is that it can target the immune reactions early in the process.
Abatacept is currently used as a treatment for already-established rheumatoid arthritis.
Experts say these findings could change how rheumatoid arthritis is managed. However, it seems unlikely that insurance companies in the United States will be willing to pay for its use as a preventive.
