Abatacept delayed rheumatoid arthritis onset by up to four years, study finds

A new study by King's College London published in the Annals of the Rheumatic Diseases shows that just one year of immune-targeted abatacept treatment delayed the onset of rheumatoid arthritis (RA) by up to four years in people at high risk. The findings, announced via Science Daily, could change the clinical understanding of RA as 'inevitable.'

The study enrolled 213 individuals in the high-risk group; these were people who were anti-CCP antibody positive and had not yet developed joint symptoms. Half of the participants received weekly abatacept injections for a year, and the other half received a placebo. At the end of a three-year follow-up period, the rate of new RA diagnoses was 26 percent in the abatacept group and 57 percent in the placebo group.

The study's lead author, King's College London Professor of Rheumatology Dr Andrew Cope, said in commentary relayed via Science Daily that 'we are moving from the paradigm where RA has traditionally been treated after diagnosis to an era where we intervene before the disease begins.' Cope stressed that the T-cell activation blockade mechanism of abatacept is effective in the early pathogenesis phase of RA.

Abatacept is already a licensed biologic agent for RA treatment; it is marketed by Bristol Myers Squibb under the trade name Orencia. The annual cost of treatment is approximately 13,000 pounds. The study findings are part of the multi-centre APPRIPRA trial sponsored by the pharmaceutical company and covering 14 centres in the United Kingdom, Germany and the Netherlands.

Dr Caroline Ospelt of the King's College London Rheumatology department said 'when we look at the average 2.7 years of follow-up after treatment, the proportion of individuals in the abatacept group in whom the disease-triggering process was completely halted was 18 percent.' That figure represents an important data point showing the long-term protective effect of a short-term intervention.

The study results raise the question of how a preventive rheumatology approach should be structured in practical implementation. Clare Jacklin, CEO of the National Rheumatoid Arthritis Society (UK), said via Science Daily that 'designing preventive treatment becomes difficult without a primary-care system that can do early risk screening; policy change is needed.' Jacklin noted that around 11,000 new RA diagnoses are made annually in the United Kingdom, with around a third of patients still waiting for diagnosis six months after their initial assessment.

In terms of cost effectiveness, an ancillary analysis of the study shows that the annual cost would need to fall below 9,000 pounds for NICE to issue a positive recommendation for preventive use. Dr James Galloway of the Department of Health Economics at King's College London said 'when we adapt the trial data to standard NICE thresholds, preventive use provides four to six quality-adjusted life years gained per year.'

The American College of Rheumatology in the United States has announced that the findings will be reviewed by its evaluation committee in early 2027. Academy president Dr Deborah Dyett Desir told the BBC that 'the concept of pre-RA intervention is a new area for us rheumatologists; we will need to revise our clinical guidelines.' Desir stressed that the issue of how the cost of screening for anti-CCP antibody-positive individuals will be covered by insurance systems is an important agenda item.

The prevalence of RA in Turkey is around 0.7 percent of the adult population. Professor Murat İnanç, president of the Turkish Society of Rheumatology, said 'an early intervention approach, if it can be turned into a structural programme in our country, could deliver reductions in long-term health spending.' İnanç added that RA patients in Turkey reach their first rheumatology consultation on average within 11 months, and this duration negatively affects treatment outcomes.

In the editorial commentary of the study, Annals of the Rheumatic Diseases associate editor Dr Iain McInnes described the findings as 'an important turning point in the history of rheumatology.' McInnes stressed that extending preventive treatment to all RA risk groups must be confirmed by long-term randomised follow-up studies. The six-year follow-up phase of the APPRIPRA trial will be completed in 2027, after which steps to standardise preventive use will be taken. This article does not constitute personal medical advice; rheumatologists should be consulted for treatment options.