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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)
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)
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
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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)
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
Links:
David Liew drdavidliew ( View Tweet)
RheumNow’s expanded coverage of the #ACR25 annual meeting is sponsored by Bristol Myers Squibb, Novartis, and UCB. All coverage content is independently selected by RheumNow and its faculty.
Dr. John Cush RheumNow ( View Tweet)
In AxSpA, an 8-week personalized exercise program improved trunk strength (+14.1%), mobility (+14.9%), and cardiorespiratory fitness ( increased oxygen pulse, ventilatory efficiency, anaerobic threshold). BASDAI and chest expansion also improved. Supports tailored rehab based on https://t.co/jawosa2AJK
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Abstract 2690: Food as a Medicine
Mediterranean vs low-calorie DASH vs control diet in PsA (multicenter RCT):
🔹 All 3 groups showed significant weight loss & DAPSA by wk 24
🔹 Weight loss not diet type may be the driver of clinical improvement
@RheumNow #ACR25 https://t.co/rBS3HR1HXl
Akhil Sood MD, MS AkhilSoodMD ( 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
Links:
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
#ACR25 Clinical Preview by Prof Coates to be applied tomorrow!
GC #steroid burden & Mx
Abstr#738 Survey of #GCA patients in US & EU: 3/4 were still on GC; mean 5.3mg/d
Abstr#1526 International consensus of GC taper in #SLE is available & can be applied in clinic
@RheumNow https://t.co/paw7NGjs4p
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Does diet matter in PsA?
Randomized study comparing advice, DASH low calorie, Mediterranean diet
Seems that weight loss corresponds better with benefit than diet. BMI reduction remains focus in PsA
Laura Coates #ACR25 meeting review @RheumNow https://t.co/CqR25sJdDc
David Liew drdavidliew ( View Tweet)
New biomarkers in axSpA. In early axSpA (DESIR cohort), higher baseline Phospholipid transfer protein (PLTP) activity was linked to sacroiliac radiographic progression over 5 years. Lower zonulin and lipopolysaccharides (LPS) levels also associated with progression. Highlights https://t.co/1uBtR4QA97
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
