New hope for people with rheumatoid arthritis?
The doctor whose research has led to newspaper claims of a cure for rheumatoid arthritis has predicted that the drug could be available within the next three years.
To date only 20 patients have been treated with a new drug therapy as part of a small-scale trial, and all but two have shown a great improvement. Five now lead a normal life, according to Professor Jo Edwards, consultant rheumatologist at University College, London.
The new treatment, rituximab, will be tested on a further 150 patients during international clinical trials lasting two years.
"We would need to supervise these 150 patients carefully for two years before there was enough information to file for a licence, but I believe the drug would be generally available within three years," said Professor Edwards.
The drug company funding the work, Hoffman la Roche, would file for a licence on the basis on results from this trial. A further trial involving up to 1,000 patients will probably follow.
The drug is currently used to treat 80,000 patients with lymphoma, so information about its safety and tolerability is already available.
Professor Edwards said he was extremely encouraged by the results of a small trial of the drug on 20 patients over 18 months.
"We are 98 per cent confident that the first ten patients on this study did better than other patients who are taking anything currently available," he said.
Professor Edwards, who announced the findings of the role of B-cells to the American College of Rheumatology in Philadelphia on November 6, said although some of the coverage given the breakthrough by some of the British press had been rather over the top, the general message was clear.
"I have described the drug as a possible or potential cure, but I have made clear that we are not claiming it as a cure at present. Patients by and large are sensible enough to realise that we are not claiming that," he added.
Dr Madeleine Devey, ARC Scientific Secretary, reacted with cautious optimism to Professor Edwards' work. "Whilst this research looks to have great potential, it is far too early to be talking about a cure, after the small number of patients treated so far," she said.
"Larger clinical trials need to be held, and data needs to be made available before we know if its early promise is justified. I believe there is a long way to go before this treatment becomes widely available."
Professor Edwards' work focuses on the role of B-cells, white blood cells that defend the body against viruses and bacteria by making antibodies. Rogue B-cells also attack healthy tissue, and trigger the production of copies of themselves. This results in the joints being attacked, leading to rheumatoid arthritis.
The UCL team has used rituximab to destroy the body's B-cells. After a single treatment, the body responds by making fresh ones, which have only a small chance of repeating the mistakes of their predecessors and triggering off the rheumatoid arthritis again. People can live for five years without B-cells, with apparently no side effects. The patients treated so far have received the drug in combination with cyclosphosphamide, a disease-modifying anti-rheumatic drug currently widely used in the treatment of rheumatoid arthritis, and the steroid, prednisolone.
