Eventually, a few patients received the anti-TNF drug the researchers obtained from a biotech company. And Dr. Maini said he’ll never forget “Patient 6” in an experimental study, who he said marked a crucial point in the era of RA biologics. The patient, a 20-year-old woman with relatively recent RA onset, had such trouble walking it was hard to live a normal life. In a video shot four weeks after injection of the drug now known as infliximab, she was walking so well she seemed light of foot.
Today, at tertiary centers remission is possible in 30% of patients and at least low disease activity in 80%.
“There’s been a huge change, which is reflected in real life in rheumatology clinics, and in the experience of general practitioners worldwide who have access to modern therapies,” Dr. Maini said, not due only to biologics, but also to much better use of synthetic disease-modifying anti-rheumatic drugs in a treat-to-target fashion.
But Dr. Maini remains preoccupied with better outcomes, both through scientific advances and through prevention by curbing tobacco use, consumption of sugary drinks, high-salt diets and other factors.
“Some people tell me, ‘Why are you fussing? You’ve done the work. It’s finished, it’s done, you don’t need to do anymore,’” he said. “I think that’s a very, very short-sighted view, because in fact, even this very optimistic picture tells us there are a number of patients who aren’t doing well.”
New technologies will drive the field forward, he said. With advances such as CRISPR (i.e., clustered regularly interspaced short palindromic repeats) genome editing and single-cell mass cytometry, researchers will need powerful technology to take advantage of an avalanche of information.
“That’s a formidable amount of data if you think about it,” he said, “And to make any sense of this kind of data, we’re going to need big data and artificial intelligence. Thank goodness big data and artificial intelligence are keeping pace with laboratory breakthroughs.”
The ultimate therapy, he said, would look similar to penicillin—a treatment that remains simple and brief.
“We really do need something that, basically with short-term exposure, leads to a long-term benefit,” he said. “That’s the ideal.”
Thomas R. Collins is a freelance writer living in South Florida.
