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Rheumatoid arthritis is a debilitating inflammatory condition, affecting around 500,000 people in the UK and around 0.5-1% of the adult population worldwide. Using novel techniques to study human synovium, Professor Sir Marc Feldmann and Professor Sir Ravinder Maini from the Kennedy Institute of Rheumatology identified a therapeutic target, TNFα, for treatment of rheumatoid arthritis. Following successful clinical trials, showing the safety and effectiveness of this new target, anti-TNFα antibodies have now become the gold standard treatment for severe rheumatoid arthritis worldwide. In addition to dramatically impacting patient care, anti-TNFα antibodies represent the largest group of therapies against rheumatoid arthritis on the market, with annual sales currently exceeding US$24.4 billion.
Research in Leeds led by Professor Paul Emery pioneered early diagnosis and treatment for patients with rheumatoid arthritis (RA), with the aim of disease remission rather than reduction of symptoms. This approach has transformed management of RA and is now standard practice for patients worldwide. It has led to greatly improved disease control, increased quality of life and reduced disability as well as direct productivity gains of an estimated £4 million per year to the UK economy.
Psoriatic arthritis (PsA) is a chronic inflammatory disease of joints, skin and tendons that affects 0.5-0.8% of the population worldwide. PsA can cause substantial psychological and social problems and also causes increased risk of death from cardiovascular disease. Research conducted by Prof Iain McInnes at the University of Glasgow in partnership with leading pharmaceutical company, Janssen, has provided robust evidence of the clinical benefits and safety of the cytokine blocker ustekinumab, leading to its approval for use for PsA by the European Medicines Agency in July 2013. This was the first approval of a PsA drug with a new mode of action in a decade, providing a novel treatment for approximately 1.25 million PsA patients across Europe.
When anti-TNF therapies (which block tumour necrosis factor) were first licensed in 1999 only a few hundred patients with rheumatoid arthritis had received them, most for relatively short periods of time. Although the drugs represented a major breakthrough, `real-world' effectiveness and safety were unproven. Research at the University of Manchester (UoM) has addressed this knowledge gap and has successfully refined the ways in which anti-TNF drugs are used around the world, leading directly to more effective prescribing and improved patient outcomes. The research has also provided strong evidence that women do not need to discontinue anti-TNF treatment prior to conception.
An estimated 1% of UK adults suffer from rheumatoid arthritis and the long-term pain and disability associated with it, Historically, however, treatments focused on relieving symptoms and did not control the arthritis itself or prevent disability. An extensive series of clinical trials and associated research programmes at King's College London (KCL) over 20 years has now significantly improved treatment recommendations and thus quality of life for thousands of rheumatoid arthritis patients in the UK, Europe and other countries. Multicentre trials of intensive treatments using conventional drugs have extended the range of drugs available, established the effectiveness of early intensive treatment, and shown that early combination therapies are safe.
Since 1998 the University of Leeds has developed the Leeds Foot and Ankle STudies in Rheumatology (FASTER) programme — to drive improvements in UK musculoskeletal foot care services. Results from FASTER clinical trials and a national survey of podiatry services directly informed NICE guidelines on foot care in arthritis. FASTER's research also provided key evidence for a national consensus on standards of care and aided a shift in the treatment paradigm for foot care in arthritis patients. These standards and NICE recommendations are included in the latest Royal College of GPs curriculum. They have also informed government policies on commissioning for podiatry services throughout England. Since the inception of the FASTER programme independent reports suggest that access to foot health services for people with rheumatoid arthritis has increased from less than 50% immediately prior to FASTER, to nearly 80% of patients today.
Research at UCL pioneered B cell depletion to treat rheumatoid arthritis (RA) and also stimulated the development of B-cell-directed therapies for other autoimmune rheumatic, haematological and neurological diseases. Now NICE approved, B cell depletion (based on rituximab) in RA is as effective as the alternative (anti-TNFα drugs) and an option for patients unable to gain benefit from anti-TNFα drugs. Rituximab offers drug-cost savings of up to £5,000/annum/patient and for many is a more convenient therapy, being given as an infusion only every five months apart, or more. B cell depletion has also proved to have an excellent safety profile, with many receiving repeated courses of treatment. As a consequence of UCL research, rituximab has brought substantial benefit to patients with many autoimmune diseases, including over 200,000 who have been treated with rituximab for RA so far.
Research at UCL into the use of tocilizumab has led to a new treatment and improved care for patients with juvenile idiopathic arthritis (JIA) and rheumatoid arthritis (RA) in adults. The drug is now approved around the world and recommended by NICE guidelines and is the standard of care in children with systemic onset JIA. It has been prescribed in every rheumatology centre in the UK for patients with severe RA. The impact of the drug on patients is to prevent disability, halt joint damage, improve function and increase quality of life.
Subcutaneous allergen immunotherapy is highly effective in hayfever sufferers who fail to respond to anti-allergic drugs, but carries the risk of severe allergic side-effects. Professor Durham's group at Imperial College have defined the mechanisms and shown that sublingual tablet immunotherapy is an effective, safer alternative that induces long-term disease remission. The tablet approach is now widespread in Europe and is being successfully extended to other allergies (housedust mite) and internationally (ragweed allergy in USA and Japanese Cedar pollen allergy). The work is quoted in guidelines internationally and regulatory bodies now recognise the disease-modifying potential of immunotherapy and its ability to induce long-term remission.
Rheumatoid arthritis (RA) is a common destructive joint disease, causing pain and swelling, affecting 1 in 100 people. Work conducted by the University of Birmingham's Rheumatology Research Group has shown that early diagnosis is important, as the first few months represent a critical therapeutic window during which treatment can significantly improve health outcomes, increasing the chances of achieving disease remission and reducing the rate of progressive joint damage. The group have demonstrated that there are significant delays in patients making initial contact with their GP, which leads to delays in referral to a Rheumatologist and starting treatment; this situation has been shown to be worse in patients of South Asian origin. The outcome of the work has been incorporated into national policy documents and clinical guidance material and has underpinned a patient focused campaign to raise awareness of the disease and the need for early diagnosis.