Beyond the Breakthrough: Equity and Access in CAR-T Cell Therapy for RA Save

At ACR Convergence 2025, abstract 1039 entitled, “Global Cost-Effectiveness and Equity in CAR-T Cell Therapy for Rheumatoid Arthritis” adds a critical dimension to the growing enthusiasm around cellular therapies in autoimmune disease. While CAR-T cell therapy has shown promise in refractory rheumatoid arthritis (RA), this systematic review of over 400 studies highlights the urgent need to address its economic and ethical implications.

With treatment costs exceeding $500,000 per patient and cost-effectiveness ratios surpassing $750,000 per QALY, CAR-T remains inaccessible to most health systems. Alarmingly, fewer than 5% of CAR-T studies include low- and middle-income country (LMIC) sites—despite rising rheumatic disease burdens in these regions. Even within the U.S., access is limited to elite academic centers, with socioeconomic status, insurance coverage, and geography acting as gatekeepers. The pressing question is not just whether CAR-T works in RA—but who will benefit.

The authors propose actionable strategies to democratize CAR-T access. Tiered pricing models, already piloted in oncology, have achieved up to 60% cost reductions. Expanding LMIC-centric trials could foster regional expertise and more representative data. Emerging allogeneic (“off-the-shelf”) CAR-T platforms may reduce costs by eliminating individualized cell harvesting and production delays. Safety innovations like ON/OFF switches could further lower hospitalization needs, making outpatient administration feasible.

This abstract positions CAR-T at the intersection of biomedical progress and social responsibility. As rheumatology embraces cellular therapies, the field must confront the disparities they risk exacerbating. Equitable deployment—through cost reform, global collaboration, and inclusive research—will determine whether CAR-T becomes a universal breakthrough or another marker of inequity.