Recent research has revealed that an established drug used for treating rheumatoid arthritis, known as abatacept, may also play a crucial role in delaying the onset of autoimmune diseases, including arthritis and type 1 diabetes. This discovery represents a significant step towards the ambitious goal of preventing these conditions before they fully develop.
According to Professor Lucy Donaldson, director of research at Arthritis UK, the ability to intervene early with existing treatments could alter the disease trajectory for many at risk. “We have the possibility that we could get in early and give something that would halt the progress, or at least slow it down,” she stated. The implications of this research could be far-reaching, as autoimmune diseases affect approximately one in ten people globally.
Understanding Autoimmune Diseases
Autoimmune diseases occur when the immune system mistakenly attacks the body’s own cells. In conditions like rheumatoid arthritis, the joints are targeted, leading to pain and inflammation. In type 1 diabetes, the immune response damages the pancreas, hindering insulin production. Other autoimmune diseases, such as inflammatory bowel disease, can severely impact the digestive system, sometimes necessitating surgical intervention.
Historically, treatments for these conditions have focused on broadly suppressing the immune system using medications like steroids, which, while effective, increase susceptibility to infections. Over the last two decades, biologic drugs have emerged as a more tailored approach. These medications selectively inhibit specific immune cells or their signaling molecules, significantly improving treatment outcomes for many patients.
Preventing Onset of Autoimmunity
Recent trials have suggested that biologics could be used not just for treatment, but also for prevention. The research published in The Lancet Rheumatology focused on individuals exhibiting early signs of autoimmune disease, specifically those with autoantibodies in their blood. These autoantibodies indicate the beginning of an autoimmune response, often years before symptoms manifest.
In the first phase of the study, participants receiving abatacept experienced a dramatic reduction in the development of arthritis—only 6 percent developed the disease compared to 29 percent in the placebo group. The second phase indicated that the effects of treatment persisted for up to four years, suggesting that the drug could fundamentally alter the immune system’s disease-causing mechanisms.
Professor Andrew Cope, a rheumatologist at King’s College London, emphasized the significance of these findings. “It shows that if you identify people where the autoimmune disease is motoring, and you target it, you can actually attenuate or even switch it off,” he explained. If future research supports these findings, long-term use of abatacept could indefinitely postpone the onset of arthritis in individuals with autoantibodies.
The potential for these findings extends beyond rheumatoid arthritis. Similar strategies are being explored for type 1 diabetes, where another biologic drug, teplizumab, has shown promise in delaying the onset of the disease by an average of two to three years. For children and young adults, this delay could significantly ease the burden of managing a complex condition.
Dr. Rachel Besser, a paediatrician at the University of Oxford, noted the importance of such interventions. “The management of type 1 diabetes is challenging, and even a small delay can make a substantial difference in the quality of life for young patients,” she said. Teplizumab was approved by the Medicines and Healthcare products Regulatory Agency (MHRA) in August 2023 and is currently under review for use within the National Health Service.
As research continues, there are efforts to identify other autoimmune conditions that may benefit from similar preventative approaches. A new study is underway to find biomarkers that could signal the impending onset of inflammatory bowel disease, potentially allowing for early intervention.
Professor Donaldson expressed optimism about the future. “The cross-fertilization of understanding different mechanisms in various autoimmune conditions is vital,” she said. “It could lead to step changes in how we approach prevention and treatment.”
The advances in biologic therapy not only represent hope for millions living with autoimmune diseases but also signify a paradigm shift in medicine towards prevention rather than mere treatment.
