- A research team from the Washington University School of Medicine have found that drug
combination could be effective in chikungunya
- Anti-viral drug and drug for arthritis found to lower
the swelling of joints and the number of immune cells present in the
- Viral load lowered during the acute phase of the
disease but viral genetic material remains during the chronic phase
A new combination of
drugs was found to eliminate chikungunya arthritis in a study conducted by a
research team from the
Washington University School of Medicine in St. Louis. The
scientists used a combination of drugs for chikungunya virus and a drug for
This could herald a new line of
treatment for the painful condition which is currently devoid of any treatment
Associate professor of
medicine, Dr. Deborah Lenschow who is also the co-senior author of the study
said that the scientists found that a combination of these two drugs could
completely remove arthritis in mice in the acute phase of the disease. This is
the phase that occurs during the first three weeks of the infection and is
characterized by debilitating pain.
‘Prospective therapy for chikungunya could be a combination of arthritis and anti-viral drugs.’
The study that was
published in the journal Science
could provide a potential drug therapy for
chikungunya arthritis. The chikungunya virus was restricted mainly to South
Asia and East Africa till about ten years ago but it has spread across the
world. In late 2013, it was found for the first time in the Western Hemisphere
and soon, by the end of 2015, it was found to have infected about 1.8 million
people in America.
The symptoms of the
disease, which is transmitted by mosquitoes, include rash, fever, muscle pain
and fatigue with most people continuing to be affected by joint
even after 6 months of the start of infection. In some cases,
severe arthritis may continue for many years after the initial infection.
Dr. Lenschow said that
there were many people who visited her clinic with symptoms that resembled
rheumatoid arthritis but who were infected with chikungunya. The similarity in
symptoms prompted the scientists to wonder if the drug used for rheumatoid
arthritis would be effective against chikungunya arthritis.
Drugs for Rheumatoid Arthritis
Dr. Lenschow and Dr.
Michael Diamond, who is the co-senior author of the study, along with
colleagues tested six rheumatoid arthritis drugs
were approved by the Food and Drug Administration. The panel of drugs was
tested on mice with chikungunya arthritis.
The main mechanism of
action of all the six drugs was to suppress the immune system, but by following
different pathways of action.
the Rheumatoid Arthritis Drug
Chikungunya virus was
injected into 7 groups of mice by the research team at the start of the study.
After a period of three days, the mice were injected with one of the six
arthritis drugs or a placebo. The research team measured
- The extent of swelling around the joints
- The numbers of molecules and immune cells that were
present in the joint
The findings of the
and Tofacitinib were two of the six rheumatoid
arthritis drugs that were found to significantly reduce
the swelling along with a decrease in the levels of immune cells and
- The number
of live viruses did not increase in the mice that were administered
with any of the six rheumatoid arthritis drugs.
Dr. Herbert S. Gasser
who was a part of the research team that conducted the study and who is a
professor of medicine said that there were concerns initially about using
immunosuppressive drugs as they could block the immune system from eliminating
the viruses, resulting in the increase in the viral load. This is normally the
case with other viruses, however, the chikungunya virus did not respond to an
increase in numbers, which could indicate that the drug could be safely trialed
The treatment of
chikungunya arthritis was only successful in part which the researchers believe
could be increased by the addition of human antibodies against the virus.
Rheumatoid Arthritis Drug and Anti-Viral Drug
In this part of the
study, the research team administered
- Abatacept- the arthritis drug
- Anti-viral drug
- Or both drugs
The findings of this
part of the study were that
- Each drug reduced joint swelling independently, after a
week of infection.
- The use of abatacept along with the anti-viral drug resulted in the elimination of the joint swelling and the infectious virus from the
- The drug interventions were found to be useful during
the acute phase of the infection but were not effective in the chronic
Chronic Phase of the Disease
The chronic phase of
chikungunya among humans begin three weeks after the initial infection and can
last for as long as three to four years when the joint pain still exists.
However, unlike in the acute phase, the virus may not be present in the blood,
but the viral genetic element present could continue to trigger the immune
system to cause tissue damage, manifested as arthritis.
of Elimination from Chronic Phase
In mice that were
treated with a combination of the drugs, both anti-viral
and drug against arthritis, the live virus was no longer found
after 4 weeks of the infection. However, the viral genetic material was found
in the joints, which is indicative that the drug combination did not affect the
chronic phase of the disease.á
The first few weeks
after infection seem to be the crucial phase and the scientists believe that
the administration of the drugs against arthritis could prevent the infection
from entering the chronic phase.á Since
there is no current treatment for the joint pain associated with chikungunya
treatment method could provide some relief. Dr. Lenschow is keen on beginning
human trials in Brazil soon to determine the effectiveness of the treatment
The acute phase of the
disease is characterized by high fever and joint pain, so an effective means of
treatment afforded by such drug combinations would benefit patients and limit
pain and discomfort, however, treatment for the chronic phase may require
- Jonathan J. Miner, Lindsey E. Cook, Jun P. Hong, Amber M. Smith, Justin M. Richner, Raeann M. Shimak, Alissa R.
Young, Kristen Monte, Subhajit Poddar, James E. Crowe, Jr, Deborah J. Lenschow, Michael S. Diamond. Therapy with CTLA4-Ig and an antiviral
monoclonal antibody controls chikungunya virus arthritis. Science Translational Medicine, February 2017 DOI:
- Chikungunya - (http://www.who.int/mediacentre/factsheets/fs327/en/)