NHS rheumatoid arthritis patients are said to benefit from a breakthrough drug that relieves excruciating pain in the joints.
The disease affects 400,000 British people – many of them young adults – who can remain seated in wheelchairs due to the pain and the associated energy-saving exhaustion.
Current treatments are able to relieve pain and reduce inflammation, but rarely completely eliminate symptoms. Some also need to be injected directly into the bloodstream, which must be done by a healthcare professional.
The new medicine Rinvoq is a once-a-day tablet that makes it easier. Clinical studies have also shown it to be remarkably effective. Up to 40 percent of users see their symptoms go away. It also works for those who are hardest hit by the disease.
A new drug called Rinvoq could make symptoms go away in 40 percent of the 400,000 patients in the UK who have rheumatoid arthritis. It could also relieve symptoms of those with the most serious form of the disease
Rheumatoid arthritis occurs when the immune system turns the body on and attacks cells that line the joints. Why this happens is not clear, but some evidence suggests that even a minor infection can bring the immune system to its knees. It commonly hits teenage or 20-year-old patients, and there seems to be some genetic element with the disease running in families. Women are also more likely to get it.
Despite the £ 10,000 a year price tag for Rinvoq, it has been given the go-ahead in England by the Drug Watchdog, the National Institute for Excellence in Health and Care (NICE), and is offered to patients who have found no relief from other treatments. Experts have called the ruling a major breakthrough, and one of the first patients to benefit from it, who once leaned on a walking stick, says he is now “jumping out of bed” thanks to the pills.
“This is very welcome news,” says Professor Chris Edwards, consultant rheumatologist at the NHS Foundation Trust at University Hospital Southampton. “Rinvoq is able to induce remission of the disease even when the disease has not responded to previous treatments.”
Rinvoq, also known as upadacitinib, is in a new class of tablets known as JAK inhibitors that transform treatments.
The drugs block the action of enzymes known as Janus kinase, which activate the immune response when the body is attacked by invading organisms such as viruses or bacteria. By blocking these enzymes, the drugs prevent the immune system from destroying healthy joint tissue.
A new drug Rinvoq worth £ 10,000 a year could help some of the 400,000 people in the UK who have rheumatoid arthritis
NICE’s approval of Rinvoq follows similar decisions for two other JAK inhibitors, tofacitinib and baricitinib – also daily tablets.
JAK inhibitors are also used to fight other autoimmune diseases such as Crohn’s disease and severe psoriasis, and are being tested as a cure for ankylosing spondylitis – a debilitating spinal disease in which the bones in the spine can fuse together.
Even baldness is a possible target, as studies have shown the drugs help trigger new hair growth.
According to Prof. Edwards, there is some evidence that Rinvoq is the most potent of the three JAK inhibitors available in the UK. “It seems to act in a different way than the other two,” he says. “The evidence suggests that this increases effectiveness. However, the best results are achieved when JAK inhibitors are given along with an old rheumatoid arthritis drug called methotrexate. “
Methotrexate helps by suppressing the immune system to reduce joint damage, but when used it can cause serious liver damage.
Clare Jacklin of the National Rheumatoid Arthritis Society says doctors need as many weapons as they can muster against the life-changing disease
Clare Jacklin of the National Rheumatoid Arthritis Society says doctors need as many weapons as they can muster against the life-changing disease.
She adds, “It is a complex disease that requires a variety of drugs. This is good news.”
Neil Feather, 55, was one of the first patients to be treated with Rinvoq in a clinical trial at NHS Teaching Hospitals in Leeds. One man’s father, an IT service manager from Wakefield, West Yorkshire, noticed about six years ago that his joints were stiff and sore.
He says, “I would get up and it would be 30 minutes before I could move – everything was stiff and painful. After sitting at a desk for a few hours, my legs gave way when I got up. I had a walking stick to get around. “
Blood tests by his family doctor confirmed Neil was in the early stages of rheumatoid arthritis – but he got lucky when the hospital looked for patients to try Rinvoq.
Neil signed up. He adds, “I felt better within a couple of weeks and jumped out of bed instead of moving. After six months on the drug, I had no symptoms at all. The pain and swelling were gone. “