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Immune Dimming or Immune Reset in RA: How Far Should We Go?

Aurelie Najm, MD, PhD Jun 06, 2026

CD19-directed CAR T-cell therapy has rapidly moved into autoimmune disease, driven in large part by striking reports in SLE, where sustained drug-free remission has raised the possibility of a true immune reset. In RA, where multiple effective therapeutic classes already exist, the relevance of such deep immune interventions remains uncertain.

#EULAR2026 LB0003 CAR-T is not scalable. In a Phase 2a of off-the-shelf AB-101 allogenic NK + low dose conditioning (Cyclo & Flud) + Rituximab: preliminary efficacy & safety profile in severe-refractory RA (N=15), SjD (11), SSc (5). Longer FU & Comparator is needed @RheumNow https://t.co/gQniufREQC

Baricitinib did not demonstrate non-inferiority w/ TNFi for first VTE in the RA-BRIDGE and RA-BRANCH trials. Identifying high-risk pts and individualizing tx is paramount. LB0009 @RheumNow #EULAR2026 https://t.co/MSiBq0FnEq

Abstr LB0009 Baricitinib vs TNFi in RA patients enriched for VTE risk. 3,640 patients. 3.7 years median follow-up. VTE: HR 1.61 (95% CI 0.97–2.66) non-inferiority not demonstrated MACE: HR 1.06 no cardiovascular excess Serious infections: HR 1.32 (p<0.05) @RheumNow https://t.co/NSNRJi9B4r

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Abstr LB0009 Baricitinib vs TNFi in VTE-enriched RA. 3,640 patients. 3.7 years. Safety endpoints VTE HR 1.61 non inferiority not met Serious infections HR 1.32 (p<0.05) MACE HR 1.06 reassuring @RheumNow #EULAR2026 https://t.co/nR6TMowlYS

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BARI vs TNFi in VTE-enriched #RA pts (RA-BRIDGE + RA-BRANCH, n=3,640, ~3.7 yrs follow-up): VTE non-inferiority not met (HR 1.61, CI 0.97–2.66). But absolute rates low (2.5% vs 1.7%) and MACE was similar (HR 1.06). Serious infections ↑ with BARI. @RheumNow #EULAR2026 LB0009

What drives progression to difficult-to-treat RA? 20-year cohort 675pts -18.8% developed D2T RA -Younger age, higher HAQ & prior steroid exposure asso w/ D2T RA -Earlier b/tsDMARD initiation protective -No diff TNFi vs non-TNFi first-line strategy Disease severity and https://t.co/SJDv9HCbLv

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#OP0209 #EULAR2026 SPECIFI-RA Balinatunfib, oral selective TNFR1 inhibitor designed to preserve TNFR2 signalling in RA. Phase 2b trial missed primary ACR20 endpoint, but 200mg QD arm showed signals for higher ACR50, ACR70 and DAS28 low disease activity & reduced IL-6. @RheumNow https://t.co/emxNQy0cPx

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#EULAR2026 #vaccination #guidelines ➡️be proactive ❎disease activity doesn’t matter ✅it is responsibility of #rheumatologist to discuss and update pt? @RheumNow @eular_org https://t.co/dRnHd9CThg

#OP0207 #EULAR2026: SUPERFIBRES trial suggests dietary fibre supplementation may enhance MTX response in RA. Inulin improved EULAR responses and Th17/Treg balance over 30 days, with strongest effects seen in MTX-treated patients. Fascinating microbiome-linked signal. @RheumNow https://t.co/nCvZlooamF

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Data of #Rituximab In #SARD-ILD Small N of #RA-#ILD pts I think data are sufficient as #RWE of #RTX in RA-ILD ✅benefits in other #CTD ILD ✅benefits in #rheumatoid #arthritis #EVER-ILD #RCT HOT #RA-ILD topic June 5 #EULAR2026 @RheumNow https://t.co/61MbsnNsaf

Is there enough data to recommend #rituximab For #ILD in #rheumatoid #arthritis @RheumNow #EULAR2026

#OP0204 #EULAR2026 Shared decision-making in practice! BACH study tested “treat by choice” in RA. Patients preferred oral JAKi over SC TNFi (55% vs 45%) Importantly, own choice led to higher treatment satisfaction, better drug survival & fewer adverse events. @RheumNow #EULARBest https://t.co/iI1n2OGzqY

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Prospective study of RVZ immunogenicity = heterogeneous cellular immunity across RMDs 12mo 150 pts -CD4+ gE-T-cell response peaks mo 3 -Response seen in axSpA + GCA, but not RA -25% of patients no CMI increase after vaccination Consistent w/other vaccine cellular imm profiles https://t.co/yvDLSHh4Bj

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#OP0203 #EULAR2026: low-dose blinatumomab in multidrug-resistant RA introduced the intriguing concept of “immune dimming”, transient B-cell depletion that appeared to restore responsiveness to previously failed DMARDs, JAK inhibitors and TNFi in several patients. @RheumNow

Frailty as a long term outcome in RA Higher frailty in RA vs ctrls HR 1.76 in 910 matched pairs. -10y: 30.6% vs 19.1% -20y: 53.8% vs 35.3% -Stronger in recent RA (HR 2.38) Driven by age, smoking, comorbidity, steroids/biologics not RF/CCP. Preventive interventions needed https://t.co/pcJrE73G5O

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Catching up on #EULAR2026 “Advanced management in RA” session: #OP0202 reported positive phase 2b RENOIR data for rosnilimab, a selective pathogenic T-cell depleter, with significant improvements in DAS28-CRP, ACR responses and CDAI LDA vs placebo in RA. @RheumNow https://t.co/IKKtakxpya

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Machine learning identifies a “vulnerable” phenotype in older RA patients n=275 -51% “vulnerable” -Worse grip strength, gait speed & SARC-F -Higher disability (HAQ 1.56 vs 0.64) -More fatigue, poorer QoL -Higher DAS28 despite greater biologic exposure Suggests we should assess https://t.co/bv1FbTxGKR

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#EULAR2026 There are over 90 abstracts on CAR-T. Please read my article on a selection of abstracts pertaining to the progress of CAR-T in rheumatic and musculoskeletal diseases @RheumNow https://t.co/2Uxy3uyF6H https://t.co/VulhEDJTEi

Depression at RA diagnosis did not predict short-term CV events in a nationwide early RA cohort -17,669 early RA pts -7.3% BL depression -Median follow-up 1.2 years -No association w/ CV hospitalisation after adjustment (sHR 1.05) Reassuring short-term data, longer follow-up https://t.co/XmMVGY1VlI

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Immune Dimming or Immune Reset in RA: How Far Should We Go?

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