A new treatment for rheumatoid arthritis (RA) could change the lives of a quarter of a million Australians affected by the debilitating disease.
Currently being trialled in the UK, the new therapy uses a patient’s own immune system to fight RA. It consists of a single low-cost injection made from the human protein BiP.
BiP is found naturally in the body and helps fight the inflammation which causes the painful joint swelling of arthritis. People with RA don’t have enough BiP in their system. Studies suggest an injection of BiP could boost a patient’s anti-inflammatory response and “reset” their immune system, helping that response last longer.
“If BiP works as we expect then a single dose should be sufficient to put patients into remission for months,” says Gabriel Panayi, Professor Emeritus of Rheumatology at King’s College London, where researchers are carrying out the first human trials of the drug.
Human trials beginning
Professor Graeme Jones, medical director of Arthritis Australia, says the injection looks promising – if it makes it through phase III trials.
“A phase III trial is definitive and proves whether something works safely,” he says. “This is the first in-human trial of the injection. For every 10 treatments that show promise, only one makes it through to humans.”
There are plenty of other things happening in the world of RA.
“Developments have been amazing in the last decade,” Professor Jones says. “Many are still in the early stages, but there is lots going on.”
They include an osteoporosis drug – zoledronic acid – that may help decrease pain and swelling in arthritis of the knee, and tofacitinib, a drug for RA that is more than halfway through a phase III trial.
“It belongs to a group of therapies called Janus kinase (JAK) inhibitors,” says Professor Jones. JAK enzymes disrupt a signalling pathway involved in the immune response.
“Inhibitors block these chemical messengers, helping prevent the damage we see in people with RA. Tofacitinib is already available in tablet form in the USA. We hope to see it in Australia later this year.”
Other treatments being tested
A treatment also under scrutiny is glucosamine, which is found naturally in the body. Studies have been undertaken to see if taking a glucosamine supplement can ease the pain of arthritis – with mixed results.
“There are numerous formulations on offer,” says Professor Jones. “Analysis of several studies has shown glucosamine hydrochloride does not work. Other research suggests glucosamine sulfate does. It has a better uptake in the body and can help manage the symptoms and progression of arthritis.”
The good oil
More studies are needed, as is the case with omega-3 fatty acids found in fish oils, which are thought to have anti-inflammatory properties that help ease joint pain. But a recent study showed surprising results.
“One group of patients took a high dose of fish oil and another took a low dose,” says Professor Jones. “We all expected the high-dose group to show more improvement, but the low-dose group won. We think it might be due to the canola oil the fish oil was mixed with.”
A canola oil trial will cost a cool $1 million. “And that’s the problem,” says Professor Jones. “For a treatment to reach phase III trials takes millions of dollars. Take krill oil. A small trial suggested it might help treat osteoarthritis, rheumatoid arthritis and cardiovascular disease. It looks promising. But a much bigger trial is needed. We are planning one, but it all takes time and money.”