HEFEI, China— While world-class athletes were contending in Beijing for Olympics medals, the lowly chicken advanced in the contest for better rheumatoid arthritis (RA) treatment. Inducing oral tolerance with chicken type II collagen (CCII) may help alleviate the signs and symptoms of RA with fewer side effects than methotrexate (MTX), according to new research published in Arthritis Care & Research1 by a Chinese research team.

“If the efficacy were to be established oral collagen would be a preferable treatment due to its minor toxicity.”—Ling-Ling Zhang, MD
“Long-term observations in large numbers of patients are needed to confirm the efficacy of CCII,” conclude researchers led by Ling-Ling Zhang, MD, of Anhui Medical University in Hefei, China. “If the efficacy were to be established oral collagen would be a preferable treatment due to its minor toxicity.”

CCII effective and well tolerated in phase II study

In the phase II, 24-week study, patients with active RA took 0.1 mg/day of CCII or 10 mg/week of MTX. Both arms showed a decrease in pain, morning stiffness, tender joint count, swollen joint count, Health Assessment Questionnaire score, and investigator and patient assessment of function, the study showed. In the MTX group, erythrocyte sedimentation rate and C-reactive protein level decreased, while rheumatoid factor did not change in either group.

At 24 weeks, 68.57% of patients in the CCII group and 83.02% in the MTX group met the American College of Rheumatology 20% improvement criteria (ACR20), and 40.95% and 57.54%, respectively, met ACR50 criteria. ACR20 and ACR50 response rates in the CCII group were lower than those in the MTX group (P <.05).

First, do no harm

The CCII treatment did seem to trump MTX in terms of side effects, the study found. GI symptoms were common in both groups, but there were fewer and milder side effects in the CCII group than the MTX group. Patients also received diclofenac sodium, which can cause GI upset but may also relieve pain and as a result could interfere with the mechanism of action and side effect profile of CCII, the authors point out.

Translating research into practice: Time to get up with the chickens?

Interest in an immunotherapy or vaccine-like approach to RA has increased in recent months, and the new chicken collagen study is expected to add to that trend.

David Trentham, MD, called the work by Zhang et al “an excellent study” and told MSKreport.com that it “will reawaken interest in this safe approach.” Dr. Trentham is chairman of the department of rheumatology at Harvard Medical School in Boston, Massachusetts and has conducted numerous studies on CCII in RA.

Reference
1. Zhang LL, Wei W, Xiao F, et al. A randomized, double-blind multicenter controlled trial of chicken type II collagen in patients with rheumatoid arthritis. Arthritis Care Res. 2008;59:905-910.