Ravinder Maini is co-Editor-in-Chief of Arthritis Research & Therapy, a journal devoted to advances in understanding the cellular and molecular mechanisms of arthritis, musculoskeletal conditions and systemic autoimmune rheumatic diseases, highlighting findings from basic to clinical research. In a three part interview, we asked Maini about what led to his seminal work into anti-TNF therapy for rheumatic disease, current and future treatments options for these conditions, as well as the role open access and clinical policy has to play.
A Career in Research
Maini is now Emeritus Professor of Rheumatology at Imperial College London, following a distinguished career in both research and the clinic that began at the University of Cambridge, UK, where he read medicine. Maini’s clinical training soon led him towards rheumatology, which sparked an interest in research and a fruitful collaboration with noted immunologist Mark Feldmann. Together Feldmann and Maini were responsible for the first anti-TNF treatments for rheumatic disease.
“Anti-TNF in these [rheumatoid arthritis] patients proved to be highly effective. So dramatically that we really doubted whether this could be sustained in the long-term.”
Maini continued to search for new treatments for rheumatoid arthritis as Director of the Kennedy Research Institute at Imperial College London, UK, from 1990 to 2002, soon after which he received a knighthood for his contributions to arthritis research.
During the course of Maini’s career, spanning over 40 years, advances in the treatment of rheumatic disease have significantly impacted the lives of patients resulting in some of the most disabling effects of the disease becoming a rarity. These benefits can be attributed in large part to the development of DMARDs (disease modifying anti-rheumatic drugs) and biological treatments such as anti-cytokine therapies, the latter pioneered by Maini and Feldmann. New therapies continue to be developed and tested, however prevention still holds the key, as Maini remarks:
“We need to understand what initiates the disease because that is the big $64,000 question. […] We’re beginning to understand environmental factors that might be critical. We now know that smoking is an environmental trigger of rheumatoid arthritis. […] So already we have a handle on prevention, which is the best way forward in the control of any disease.”
Open Access and Clinical Policy
The treatment options available for rheumatic disease vary across the globe, with economic constraints often meaning access to the most effective treatments is limited. Maini expands on the reasons for this, discussing the costs of drug development and production. Clinical trials to assess the safety and efficacy of such therapeutics have been the focus of criticism when it comes to the issue of transparency. Maini addresses the importance of clinical trial registration as well as the broader issues around open access for sharing the latest findings in arthritis research:
“Ultimately I hope there will be truly open access to all published work that you can get wherever you are, easily accessible”