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Day 1 Recap: #ACR25 Highlights
Join RheumNow Faculty Drs. Aurelie Najm, Yuz Yusof, Janet Pope and Jack Cush as they discuss highlights and key takeaways from the Day 1 Recap on Sunday, October 26th.
https://t.co/Kq8TDBLUYZ https://t.co/TNM8ZAji9w
Dr. John Cush RheumNow ( View Tweet)
CAR T
Which cells to target
What patients & what disease
When is right time
In vivo (new) ex vivo
Premeds immune suppression
What to use, ?if anything
Cons
Is it safe
?long term effectiveness
What is failure rate
ICANs and other side effects
#ACRBest #ACR25 @RheumNow #26S21 https://t.co/TUSJh1hrPr https://t.co/JiqYzgBmYP
Links:
Janet Pope Janetbirdope ( View Tweet)
Needle in a haystack
What T cell to target for #autoimmune diseases
T cell repetoires (TCR) not all are sequenced and many can exist to present antigens
Diff scales of approaches
Implications CAR-T
CD19
CD20
BCMA
Treg
HLAB27
etc!
#ACR25 @ACRheum @RheumNow
Alok Joglekar
#26S08 https://t.co/Qgw8Akz1xk
Links:
Janet Pope Janetbirdope ( View Tweet)
Prospective RCT on safety & efficacy of TAC+GC vs. MMF+GC
TAC+GC was comparable to MMF+GC as continuous induction maintenance treatment over 96 wks for LN.
AE rates comparable.
TAC - AKI & tremor
MMF - leucopenia
reassuring data.more tx options.
#ACR25 @RheumNow Abs2697 https://t.co/16Fd8zE5dL
sheila RHEUMarampa ( View Tweet)
So what's been tried for ICANS, knowing that it's unlikely that one therapy will fix all of it?
@CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/10wdkrH29s
Links:
David Liew drdavidliew ( View Tweet)
Toxicity is the big question about CAR-T in RA - what did the CRS/ICANS profile look like in this German ph1 in RA?
Pretty good so far - but obviously will be under enormous scrutiny when we are looking at diseases with good existing therapies
#ACR25 ABST0471 @RheumNow https://t.co/xXyzOwLvx8
David Liew drdavidliew ( View Tweet)
2465: Dual-target CD19/BCMA CAR-T in refractory SLE (Phase 1)
🔹All pts (n=10) met SRI-4 by wk24
🔹DORIS remission: 5 (wk24), 6 (wk36–48)
🔹Residual proteinuria (n=4); renal bx (n=3) showed resolved IC deposits & inflammation
🔹CRS Grade 1 (n=6); no ICANS
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
What does the FDA regulatory approach look like for CAR-T and T cell engages right now?
The FDA session at #ACR25 gave some clues @RheumNow https://t.co/wHNnNTrXaE
Links:
David Liew drdavidliew ( View Tweet)
LB23: Regulate-RA- ongoing Phase 1 trial of autologous CAR-Tregs in refractory RA (no lymphodepletion)
🔹 4/6 pts had ↓ DAS28-CRP by wk 4 with rapid onset & ↓ joint counts at dose level 2
🔹 Synovial biopsies to date showed ↓ inflammatory score post-tx
@RheumNow #ACR25 https://t.co/JMBbLIEmJG
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
LB04: Another approach to CAR-T, CD20+/BCMA bispecific CAR-T in refractory proliferative LN:
🔹100% discontinued biologics & IS at follow-up
🔹Renal response ~78%
🔹CRS mostly Grade 1–2 (~70%); ≥Grade 3 AEs = transient & hematologic
@RheumNow #ACR25 https://t.co/oNK4wtLGYV
Links:
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
#ACR25 Please find my blog on update and progress of clinical trials in #Sjogren #SjD @RheumNow
https://t.co/u8pxZ5FeBX https://t.co/KAnRo3Zqnz
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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
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
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
Links:
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
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
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
Links:
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
Links:
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
Links:
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
Links:
David Liew drdavidliew ( View Tweet)
