Lancet Rheumatol

Early treatment in high-risk patients can delay rheumatoid arthritis onset

January 22, 2026

ALTO, a long-term follow-up of the APIPPRA phase 2b trial, found that a 12‑month course of abatacept significantly delayed the onset of rheumatoid arthritis (RA) in individuals at high risk. The arthritis‑free survival advantage seen at 2 years persisted at 4 years (4.9‑month difference; p=0.044), although the magnitude of benefit diminished over time. Beyond the treatment period, assessments of disease activity and patient‑reported outcomes showed no significant differences between groups. Those with the broadest autoantibody profiles who were at highest baseline risk appeared to derive the greatest protective effect.

Clinical takeaway: Timely, targeted immune treatment can slow progression to RA in high‑risk individuals, reinforcing the importance of early risk stratification and supporting further research into preventive approaches.

Source:

Cope, A et al. (2026, January 20). Lancet Rheumatol. Long-term outcomes of abatacept in individuals at risk of developing rheumatoid arthritis (ALTO): a randomised, double-blind, placebo-controlled trial. https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(25)00371-6/fulltext