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2025

The 2025 Rheumatology Year in Review

Jack Cush, MD

The year 2025 presented numerous advances in rheumatology and related inflammatory and autoimmune disorders ranging from several new groundbreaking FDA approvals/indications, drug developments, game-changing guidelines and practices that will impact patient care for rheumatic diseases.

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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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B CELL DEPLETION

Taking a closer look: B-Cell depletion beyond the blood

Akhil Sood, MD

Following the landmark case series by the Erlangen group, multiple cellular therapies have entered the race—each with unique targets, constructs, and mechanisms. Yet, a fundamental question remains: How deep is the B-cell depletion? In clinical practice, peripheral blood counts often serve as our surrogate for depletion. But these may only tell part of the story.

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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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B cell Targeted CAR-T Therapy for Autoimmune Diseases The review by Qi Li and colleagues provides a comprehensive examination of the progression, clinical applications, challenges, and future directions of B-cell-targeted CAR-T therapy across multiple autoimmune conditions. https://t.co/09BnvVYfiZ
Dr. John Cush RheumNow ( View Tweet)
CASTLE Phase 1/2a CAR-T cell trial of 24 Tx refractory SLE, SSC, IIM pts w/ MB-CART19.1 (autologous CD19 CAR-T). Good safety (no CRS Gr 2 or higher or ICANS) @wk 24 & 22/24 achieved efficacy (9/10 SLE remission; 9/9 SSc no progression, 4/5 IIM major/mod response). All GC free on https://t.co/1BJidCuCeb
Dr. John Cush RheumNow ( View Tweet)
QD Clinic: CAR-T Cell Therapy for Lupus Philip Mease, MD and Cayla Alexander, DNP, ARNP, Seattle, Washington, discuss the case of a patient with lupus who underwent CAR-T cell therapy for her disease. This QD clinic is presented as part of RheumNow's "Mission: APP Partners in https://t.co/WXWOLupWna
Dr. John Cush RheumNow ( View Tweet)
CAR-T Therapy: Where is it Heading? Dr. Peter Nash summarizes several abstracts looking at CAR-T therapy from #ACR25. https://t.co/bC8p1LnZMW https://t.co/KKn3jjsBW0

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Dr. John Cush RheumNow ( View Tweet)
Off the Shelf: CAR-T Dr. Akhil Sood reports on abstract 0663 (iPSC-Derived Off-the-Shelf anti-CD19 CAR T cells Deliver Improved Clinical Outcomes in Lupus with Reduced or No Conditioning Chemotherapy) presented at#ACR25. https://t.co/mj4b5cCInC https://t.co/s34atFCMlx

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Dr. John Cush RheumNow ( View Tweet)
Are we putting the CAR-T before the horse? CAR T-cells have been a revolutionary development in rheumatology. We have seen a population of patients with severe refractory autoimmune conditions almost overnight presented with the prospect of not just improvement, but of a cure. https://t.co/gF9FXjAZ7F
Dr. John Cush RheumNow ( View Tweet)
NEPTUNUS: Ianalumab in Sjogren's https://t.co/K9Xm51Kb5X Finally good news in Sjogrens disease. @RheumNow #ACR25

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Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)

Why are vaccine Abs maintained after CAR-T -depletion of pathogenic #Abs are dampened/eliminated Clonal repetoire expansion Remission=naive B cell pop'n Reset immune system sparing memory cells vs ?not all pathogenic cells eliminated in tissue #ACR25 @RheumNow @ACRheum #26S21 https://t.co/jb3dD5Ssip

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Janet Pope Janetbirdope ( 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)
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

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Janet Pope Janetbirdope ( 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)
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

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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

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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

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Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
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