Breakthrough Drug Delays Rheumatoid Arthritis for Years After Treatment Ends

A long-term clinical study suggests that intervening before rheumatoid arthritis fully develops may significantly alter its trajectory.

Treating people before rheumatoid arthritis (RA) fully develops may buy them something medicine rarely can: time. A new long-term study suggests that in people at high risk, early treatment with abatacept can push back the start of the disease for years, with benefits that continue after the drug is stopped.

This new study from King’s College London, published in The Lancet Rheumatology, builds on results from a trial reported by the same research team in 2024.

The original trial tracked 213 participants in the UK and the Netherlands for two years. The updated analysis extends that follow-up to between four and eight years, making it one of the longest studies of people at risk of RA.

RA is a chronic autoimmune disease that affects about half a million people in the UK. It occurs when the immune system attacks the joints, leading to pain, swelling, fatigue, and long term disability.

People at risk often leave the workforce before symptoms begin, contributing to financial strain and broader economic effects.

Current Treatment Gaps and New Findings

Although treatments are available for people with established RA, no approved therapy currently prevents the disease in those who are at risk.

The researchers found that the benefits of 12 months of abatacept lasted well beyond the treatment period. Participants who received the drug developed RA much later than those given a placebo, with onset delayed by as much as four years after treatment ended.

While the therapy did not stop RA permanently, the results show that early intervention can change how the disease develops by delaying its onset. This may reduce the total time patients experience symptoms and complications.

Professor Andrew Cope, Professor of Rheumatology in the Centre for Rheumatic Diseases at King’s College London and lead author of the study, said: “Intervening early in people at high risk of RA can have lasting benefits. We have shown that this approach is safe and can prevent disease while patients are on treatment as well as substantially relieve symptoms. Importantly, it can also delay the onset of RA for several years, even after treatment has stopped. This could reduce how long people live with symptoms and complications, drastically improving their quality of life.”

Who Benefits Most From Treatment

The study found that abatacept worked best in individuals at the highest risk of developing RA. These participants were identified through a blood test that detects specific autoantibodies.

Although they were more likely to progress to RA, they also gained the greatest benefit from early treatment.

During this at risk stage, abatacept reduced joint pain and fatigue and improved overall wellbeing. However, after treatment stopped, symptom levels became similar between the treatment and placebo groups. This suggests that ongoing immune modulation may be needed to maintain symptom control.

The researchers reported that abatacept was safe, with similar rates of serious adverse events in both the treatment and placebo groups and no safety concerns linked to the drug.

Overall, the findings suggest that early, targeted immune therapy can delay the onset of RA in high risk individuals, supporting further research into preventive strategies for autoimmune diseases.

Reference: “Long-term outcomes of abatacept in individuals at risk of developing rheumatoid arthritis (ALTO): a randomised, double-blind, placebo-controlled trial” by Andrew P Cope, Marianna Jasenecova, Joana C Vasconcelos, Sumera Qureshi, Karin A van Schie, Andrew Filer, Karim Raza, Maria Antonietta D’Agostino, Iain B McInnes, Stefan Siebert, John D Isaacs, Arthur G Pratt, Benjamin A Fisher, Christopher D Buckley, Paul Emery, Kulveer Mankia, Pauline Ho, Maya H Buch, Coziana Ciurtin, Dirkjan van Schaardenburg, Tom W J Huizinga, René E M Toes, Evangelos Georgiou, Joanna Kelly, Caroline Murphy, A Toby Prevost, Sam Norton, Maria Opena, Sujith Subesinghe, Toby Garrood, Bina Menon, Nora Ng, Karen Douglas, Christos Koutsianas, Faye Cooles, Marie Falahee, Memory Nelson, Anurag Bharadwaj, Angelo Ramos, Jane Thomas, Ira Pande, David Collins, Suzannah Pegler, Sabrina Raizada, George Fragoulis, Ruby Taylor Gotch, James Galloway, Andrew Rutherford, Theresa Barnes, Helen Jeffrey, Yusuf Patel, Michael Batley, Brendan O’Reilly, Srinivasan Venkatachalam, Thomas Sheeran, Claire Gorman, Piero Reynolds, Asad Khan, Nicola Gullick, Siwalik Banerjee, Nicholas Schenker, Jane Rowlands, Mirian Starmans-Kool, James Taylor, Pradip Nandi, Ilfita Sahbudin, Mark Maybury, Samantha Hider, Ann Barcroft, Jeremy McNally, Jo Kitchen, Muhammad Nisar and Vanessa Quick, 20 January 2026, The Lancet Rheumatology.

DOI: 10.1016/S2665-9913(25)00371-6

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