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syringe, pill, DMARD, Treatment, therapy

What should head-to-head studies in inflammatory arthritis teach us?

Janet Pope, MD, MPH, FRCPC

The multimillion dollar question for inflammatory arthritis prescriptions is: which drug should I use next?

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CART

Beyond malignancy, look out for LICATS with CAR-T

Md Yuzaiful Md Yusof, MRCP(UK), PhD

CAR T cell therapy took the centre stage in 2022 where data pertaining to a successful case series of 5 patients with refractory SLE were published by Prof Schett’s group. Since then, this area of therapeutic has expanded exponentially. Our growing enthusiasm was slightly dampened though when the FDA required all six approved CAR T-cell therapies in oncology to include a black box warning regarding the risk of second primary malignancies in January 2024. At ACR25, Prof Schett’s group described a new form of toxicity in patients with autoimmune disease receiving CAR T-cell therapy, most likely due to the cleansing of immune cells from the affected organs.

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Cush and Kavanaugh

ACR 2025 Rheumatology Round Up

Jack Cush, MD

Drs. Jack Cush & Arthur Kavanaugh, two of rheumatology’s most trusted voices, provide a breakdown of the latest breakthroughs and hottest topics in rheumatology from the 2025 ACR Convergence meeting in Chicago.

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acr_session2.jpeg

ACR25 Best Abstracts - Day 4

Jack Cush, MD

Here's the last installment of our "ACR Best" abstracts as chosen by the RheumNow faculty.  Most of these were from the final, day 4, but a few were noteworthy holdovers from day 3. Enjoy!

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Halloween ACR Guidance (10.31.25)

Jack Cush, MD

Dr. Jack Cush recaps ACR2025 with suggestions on how to best learn ACR25 content from RheumNow.com and our articles, videos and podcasts.

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If We Can’t Prevent RA, Can We at Least Prevent Difficult-to-Treat RA? Despite major advances in RA management, some patients develop difficult-to-treat RA (D2TRA), characterized by ongoing inflammation and impairment despite multiple therapies. While understanding of the https://t.co/FcF0V82KdT
Dr. John Cush RheumNow ( View Tweet)
Marketscan claims study of 62,813 IMID women w/ 70,529 pregnancies & 69,412 births, 4,485 (7.1%) were exposed to at least one TNFi during pregnancy & 3,559 postpartum. TNFi use NOT assoc w/ SIE risk during Preg (HR 1.39; 0.95-2.05) or postpartum (HR 1.22; https://t.co/NsxOLpT0ds
Dr. John Cush RheumNow ( View Tweet)
Topline results of ALLEGORY study (Genentech) - 300 pt. phase 3 DBRPCT obinuntuzumab vs PBO in active SLE w/ SRI-4 primary outcome at wk 52. The anti-CD20, B-cell depleter, Rx met all efficacy endpoints primary and all key secondary endpoints. Gazyva was FDA approved last wk https://t.co/Wd6EFEjvGP
Dr. John Cush RheumNow ( View Tweet)
FDA is going to "fast-track" biosimilars to curtail the costs of expensive biologics https://t.co/h5NBsUaM97

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Dr. John Cush RheumNow ( View Tweet)

🍼 “Stop breastfeeding if on methotrexate” — that’s what we’ve always heard. But here’s the news 👇 📊 Latest EULAR lactation: Methotrexate = LoE 4 / C ➡️ May be considered in breastfeeding if no safer alternative exists. 💡Not first-line, not forbidden — just evidence-limited. https://t.co/IJEpZYMaFV

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Dr Abhilasha Manwatkar (AIIMS Nagpur) Abhilasha21822 ( View Tweet)
Upadacitinib is a Double Edged Vascular Sword in GCA Dr. David Liew discusses abstracts O751, O738, and O734 presented at #ACR25. https://t.co/eTmVehP2Cd https://t.co/vxehwRWM2D

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Dr. John Cush RheumNow ( View Tweet)
SLE Conference Preview: progress in biologics at #ACR25 We now have four licensed targeted therapies (i.e., belimumab, voclosporin and obinutuzumab for active lupus nephritis and belimumab and anifrolumab for active non-renal SLE). What are other issues to be addressed and https://t.co/uvVICAsCzo
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

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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

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sheila RHEUMarampa ( 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

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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)
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)
#Urinary #biomarkers #lupus #nephritis #Tenascin C -suggests repair, fibrosis, progress of #LN #IL16, #CD163, & more for LN activity Sometime a biomarker may replace repeat #kidney #biopsies? #AMP group #Accelerated #Medicines #Program #ACR24 @ACRheum @RheumNow abst#851

Janet Pope Janetbirdope ( View Tweet)

#GCA & #PMR @ACRheum #ACR25 #gamechangers #ACRBest Yr 2 Select-GCA abst#776 #upadacitinib in yr2 of GCA REDUCES flares HELPFUL info ?ability to get drug for 2 yrs hopefully Failed Phase3 RCT of #secukinumab in #GCA helped #PMR abst#1175 & +Ph3 for PMR REPLENISH RCT @RheumNow https://t.co/5lH6HXhnfg

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Janet Pope Janetbirdope ( View Tweet)
When should you order a renal bx in suspected #LN? Active urinary sediment Used to be #UPCR 500g/g or more Abst#772 looked at UPCR 250g/g to 499 71% + LN and half needed Rx esp if Low C3,C4 Black race Petri, Baltimore #lupus #cohort #ACR25 @ACRheum @RheumNow

Janet Pope Janetbirdope ( View Tweet)

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