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Beyond the Breakthrough: Equity and Access in CAR-T Cell Therapy for RA

Bella Mehta, MBBS, MS

At ACR Convergence 2025, abstract 1039 entitled, “Global Cost-Effectiveness and Equity in CAR-T Cell Therapy for Rheumatoid Arthritis” adds a critical dimension to the growing enthusiasm around cellular therapies in autoimmune disease.

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Abstract 1563: Ongoing Phase 1/2 trial of Rese-cel CAR-T in systemic sclerosis 🔹Pt with severe skin involvement showed improvement in mRSS (42→34), PFTs & nailfold capillaroscopy at 6 mo 🔹Grade 2 CRS, no ICANS or DLT reported Early but exciting findings @RheumNow #ACR25

Akhil Sood MD, MS AkhilSoodMD ( View Tweet)

While post-CAR-T CRS might be semi-familiar for rheumatologists, ICANS is a new concept to get our heads around, and one which is far from heterogenous. @CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/qX2jKMG2oB

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David Liew drdavidliew ( View Tweet)
@CarolineDiorio @ChildrensPhila @RheumNow Indeed, there are a lot of familiar HLH/MAS friends in the post-CAR-T CRS mix... (indeed, rheum friends from many places) @CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/OzWu3MV1FA

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David Liew drdavidliew ( View Tweet)
Another toxicity signal to watch in the CAR T space: LICATs Abstract 1537 reports a new immune-related toxicity distinct from CRS or ICANS: 🔹Affects organs prev involved in autoimmune dx: skin (35%) and kidneys (22%) 🔹Mostly mild (Grade 1–2); 3 cases Grade 3 @RheumNow #ACR25 https://t.co/mtZh47nWtv

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Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
I've always (very) simplistically considered post-CAR-T CRS and HLH/MAS in the same bucket, and there certainly are substantial similarities. It raises the obvious question - can we borrow therapies? @CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/2HkHxpl89u

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David Liew drdavidliew ( View Tweet)
What dictates how severe CRS is following CAR-T? (Often the critical question, and will especially be in the autoimmune space, where CAR-T is largely less time-critical) @CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/u0w4lx7YVn

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David Liew drdavidliew ( View Tweet)
@CarolineDiorio @ChildrensPhila eloquently told the #ACR25 BCRC pre-meeting about the lessons they've learned about CRS and ICANS, the major CAR-T toxicities. Many questions still to answer, but they've also understood a lot we can learn from. @RheumNow https://t.co/Jhk1eCLpD4

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David Liew drdavidliew ( View Tweet)
CAR-T vs bispecific antibodies - what's the difference? @andrew02114 @MGHCancerCenter with the heme-onc point of view in the #ACR25 BCRC @RheumNow https://t.co/7KJCfiQKWM

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David Liew drdavidliew ( View Tweet)
CAR-T toxicity in hematology (the things we have to look out for in rheumatology, as application of CAR-T potentially broadens) @andrew02114 @MGHCancerCenter with the heme-onc point of view in the #ACR25 BCRC @RheumNow https://t.co/1YjadL7LCF

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David Liew drdavidliew ( View Tweet)

Andrew Yee @andrew02114 of @MGHCancerCenter details out how quickly the CAR-T paradigm changed in myeloma/lymphoma - from newsworthy to routine. Now that much more about CAR-T has been worked out, will adoption be quicker in autoimmune disease? #ACR25 BCRC pre-meeting @RheumNow https://t.co/oNuPXCwWQ9

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David Liew drdavidliew ( View Tweet)
What to use in future for active #Sjogren's #SjD B cell depletion, signal attenuation Ianalumab 2+ phase3 RCTs Telitacept +RCT Nipocalimab FcRn +Ph2 Dazodalibep CD40L +Ph2 +RCTs HCQ+Lef Rituximab ?BTKi #ACR25 @ACRheum @RheumNow abst#LB24, LB11

Janet Pope Janetbirdope ( View Tweet)

Post-CAR-T myelopathy has been an issue in heme onc, and is still an unpredictable quantity without a clear cause. Will this be a problem for autoimmune CAR-T as we gain more experience? @CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/RhhdOiyEAX

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David Liew drdavidliew ( View Tweet)
CAR-T Cell Therapies Show Promise for Autoimmune Disease Two pioneering studies presented at #ACR25 spotlight the potential of CAR-T cell therapies to transform treatment for SLE and other autoimmune diseases. These early findings suggest a new frontier in immune modulation and https://t.co/KdNWmVc4Qc
Dr. John Cush RheumNow ( View Tweet)
Phase 1 study of CAR-Treg in difficult to treat RA 4/6 pts had 50% reduction in TJC/SJC, no CYC/fludrabine required & good prelim safety data CAR-T remains exciting, but less of the "totally magical everyone cured" stuff we saw w/initial CAR-T reports @RheumNow #ACR25 https://t.co/kjBIkLCYpF

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Mike Putman EBRheum ( View Tweet)
Will CAR-Treg Rx be helpful in active #refractory #rheumatoid #arthritis? Early data n=6 treated w low dose (3 per arm), ongoing and doses will escalate Improvemt in #clinical #disease #activity less inflammation on #synovial #biopsies 3 pts #LB23 #ACR25 @RheumNow @ACRheum https://t.co/PkhsvztVjx

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Janet Pope Janetbirdope ( View Tweet)
#ACR25 Abstr#2695 Inguinal lymph node biopsies pre- and post-OBI, RTX, BLIN & CD19 CAR-T showed complete tissue depletion with CAR-T. B-cells reduced but often incomplete with protein-based depleters; OBI being the best. Still don’t agree with “immune reset” @RheumNow #ACRBest https://t.co/Sq7m9sXlLP

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Abstract 2696: Phase 1/2 study of rapidly engineered CD19 CAR T showed: - rapid depletion of CD19 B cells w/ recovery by Day 90 - Days 180 and 360: returning B cells largely naive (CD27-IgD+) - Interferon expression ↓ after CAR T treatment @RheumNow #ACR25 https://t.co/FzdFbqWwtE

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Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Abstract 2695: Deep dive into B-cell depletion (BCD) Lymph node biopsy pre/post tx: 🔹 CAR T: complete BCD + disrupted follicular architecture 🔹 RTX, OBI, BLIN: reduced BCD + preserved follicular architecture ✅ Complete LN depletion → drug-free remission @RheumNow #ACR25

Akhil Sood MD, MS AkhilSoodMD ( View Tweet)

Kohler et al. Phase 1 study autologous CAR-Tregs in refractory RA. No lymphodepletion needed! 6 participants. 2 doses, second cohort with higher dose better and more sustained response. No CRS or other toxicities. @RheumNow #ACR25 Abstr#LB023 https://t.co/nWva2R7WOQ

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Richard Conway RichardPAConway ( View Tweet)
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