Treating rheumatoid arthritis with a drug currently used only when patients are severely disabled appears to slow the progression of the disease dramatically, a study suggests.

A trial involving rituximab, an advanced antibody drug, has shown a remarkable reduction in symptoms for patients in the early stages of the disease. It has led one expert to claim that it could lead to a “paradigm shift” in the use of arthritis therapies.

Almost 500,000 people in Britain are affected by rheumatoid arthritis, which occurs when the body’s immune system attacks the joints. About 40 per cent of sufferers are forced to stop work during the first five years of their illness. The condition costs the economy about £4 billion a year.

A total of 755 patients took part in the Image trial, led by Professor Paul-Peter Tak, from the University of Amsterdam. All participants had recently received an arthritis diagnosis and had generally suffered the disease for less than a year.

After a year of treatment, those receiving a combination of methotrexate, a “gold standard” early-stage treatment, and rituximab were found to be three times as likely to have fewer symptoms — and a reduction pronounced enough to meet the criteria for remission — than those on methotrexate alone. During the second six months, continuing joint damage was almost completely halted in patients treated with rituximab.

Currently most patients go through a set order of treatments as the disease progresses, moving from ordinary anti-inflammatory painkillers, such as ibuprofen, to anti-rheumatic drugs such as methotrexate, which slow progression and delay joint damage.

In severe cases newer drugs called biologics may be used, including treatments that block an immune system signalling molecule called tumour necrosis factor (TNF). Under current guidelines, patients qualify for rituximab, which is marketed as MabThera, only on failing to respond to an anti-TNF. Originally developed to treat leukaemia, the injected drug targets specialised white blood cells that play a key role in the immune response behind rheumatoid arthritis.

Of the patients receiving the methotrexate and rituximab combination, 30.5 per cent experienced significant reduction of symptoms, compared with 12.5 per cent taking only methotrexate. A course of rituximab treatment costs £3,492 — significantly less than the £12,000 cost of a typical anti-TNF drug. Coupled with the new trial data, this is likely to have a bearing on how rituximab is made available.

The findings were presented last week at the annual meeting of the European League Against Rheumatism (Eular) in Copenhagen. Professor John Isaacs, a leading rheumatologist from the Institute of Cellular Medicine at the University of Newcastle, said: “These positive data clearly show the efficacy of using rituximab earlier and could signal a paradigm shift in the use of this drug.”

A task force of Eular experts is developing new evidence-based guidelines for the management of rheumatoid arthritis. Ailsa Bosworth, of the National Rheumatoid Arthritis Society, said: “These results are a very encouraging sign for the future for patients in the early stages. If I could have prevented damage when I was first diagnosed, it would have changed my life.”

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