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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
Links:
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)
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
Links:
David Liew drdavidliew ( View Tweet)
#SLE #DORIS #remission is RARE and without #prednisone even rarer
#ASIA #Pacific 5K pts over 10 yrs
A call to do better
82% LLDAS, 70% remission, 31% GC-free remission (REM-0) at least once
abst#595 @ACRheum @RheumNow
#ACRBest https://t.co/OK6sYnqs81
Janet Pope Janetbirdope ( View Tweet)
Rheum Now Rheumatology Round-Up — LIVE
Join Drs. Jack Cush & Arthur Kavanaugh for this livestream with two of rheumatology’s most trusted voices: this Friday, Oct 31 at 12 PM CST for break down of the latest breakthroughs and hottest topics in rheumatology from #ACR25.
📡 Live https://t.co/G6jKiHYVoR
Dr. John Cush RheumNow ( 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)
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)
#MTX is NOT the same as TCZ in #GCA in RCT
#TCZ did better
So use an advanced Rx for GCA
ex TCZ, Upa when approved
METOGiA RCT - more relapses in MTX
abst#891 #ACR25 @ACRheum @RheumNow https://t.co/wsEKGF8dW2
Janet Pope Janetbirdope ( View Tweet)
Will #PAD4 levels predict pts w #CCP positive #arthralgia who will develop #RA?
Leeds study - 79 at risk pts
PAD4 levels may predicting #rheumatoid #arthritis development
#ACR25 @RheumNow @ACRheum abst#832 https://t.co/dnAA6z3NJQ
Janet Pope Janetbirdope ( View Tweet)
