The impetus for this program, called “Within Our Reach: Finding a Cure for Rheumatoid Arthritis” (WOR) is a combination of the current funding situation in biomedical research and opportunity. “The campaign comes at a time when funding at the National Institutes of Health (NIH) has been flat or decreasing,” says Dr. O’Dell, who is also vice chairman of internal medicine and chief of the section of rheumatology at the University of Nebraska Medical Center in Omaha. This trend aggravates the existing situation in which RA is underfunded in the world of medical research. Although RA affects more than one in every 200 Americans, costing over $80 billion annually in the United States, research funding is equivalent to only $26 per patient, versus, for example, $270 for type 1 diabetes or $330 for multiple sclerosis, according to the National Institutes of Health (NIH).
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Explore This IssueSeptember 2007
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The campaign grew out of a scientific meeting, convened in Boston in 2005 by the REF board of directors, that assembled 60 of the world’s top rheumatologists, along with representatives from the NIH and Arthritis Foundation. The goal of the meeting was to determine the field’s most promising research opportunities. The meeting laid the foundation for the grant program. “We set the ambitious goal to raise $30 million and spend it over five years,” says Dr. O’Dell.
Many Avenues for Research
There is still much to be learned about RA that could greatly improve treatment for many patients. For example, for those patients taking methotrexate who continue to have active disease, there are many other therapies, involving over 10 different agents, but no data comparing their efficacy, says Dr. O’Dell, who also founded the Rheumatoid Arthritis Investigational Network, which he has directed for the last 16 years. More generally, “we don’t know how to integrate [various treatments], we don’t know when in the course of disease to use them, and we don’t know which patients will benefit,” he says.
The field is ripe for advances. For example, “we know a lot about RA at the genetic level. We know a lot about inflammatory parameters that some [patients] have and others don’t, and we believe strongly that when we put all that together we will be able to pick out patients who will respond dramatically to therapy A, but not to therapy B,” says Dr. O’Dell.
The WOR grants will support research so novel and innovative – and consequently, high risk – that it would be unlikely to attract NIH funding. These days, “You almost have to have half of the work done before you can be successful with an NIH grant,” says Dr. O’Dell. There are three categories of WOR grants, which have gone through a first round of funding, that provide $400,000 over two years:
- Innovative research: These grants fund research leading to a new understanding about the cause of RA and the development of novel drugs. “Innovative basic research is the real target,” says Dr. O’Dell, “and that implies taking risks on research that hasn’t already shown it’s going to work, but that has the possibility of advancing our knowledge base in a big way. It’s like stepping up to the plate with a chance to strike out or hit a home run.”
- Translational research: These grants aim to translate basic lab research into improved patient care and facilitate the application of innovative research on new approaches to diagnosis and treatment. Among areas of interest is the development of methods to repair and replace damaged cartilage and bone.
- Clinical practice: These grants will focus on research to enable doctors to identify individuals at risk for RA before symptoms arise as part of efforts to promote prevention and early treatment. Additionally, says Dr. O’Dell, these grants will seek to define success in treating RA patients, in part by testing “how well new definitions [of success] hold up using more sensitive imaging techniques such as MRI.” Finally, there will be grants for studies that can help clinicians determine how to best walk the tightrope between maximum clinical improvement and side effects.
So far, 15 researchers – about 20% of those who sent in proposals – have been funded, with projected expenditures of $6 million.