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CD19 CAR T Cell Therapy in SLE (9.16.2022)

Sep 16, 2022 4:00 am

Dr. Jack Cush reviews the news, journal reports, ACR and FDA announcements from the past week on

  1. First In Class, TYK2 Inhibitor FDA Approved for Psoriasis

  2. 2022 New ACR Guidance on Glucocorticoid-Induced Osteoporosis (GIOP) 

  3. 2022 Univ of Michigan Natl Poll on Healthy Aging finds that 70% of older adults reported joint pain (more in Women 75% vs 65%M).  60% MD dx ARTHRITIS-- 30% have a HCP dx of #OA, 8% RA, 7% gout or pseudogout & 5% w/ another kind of arthritis

  4. Taiwan population study shows increased all-cause mortality for psoriasis patients (HR 1.16; 1.13-1.19) vs. general population.

  5. Study of 247 consecutive PsA pts shows that two-thirds (63.15%) had poor sleep quality. Poorer sleep was assoc w/ being female, higher joint counts, greater peripheral and axial disease activity, but fatigue & anxiety most explained poor sleep quality

  6. Open label, noninferiority study TNFi withdrawal in 64 PsA & 58 axSpA pts. 2/3 tapered by dz activity T2T strategy (N=81) & 1/3 continued TNFi. At 12 mos. LDA seen in 69% w/ Tapering (~avg 53% dose) vs 73% no-tapering group (91% dose)

  7. 534 PsA & 470 AS pts (SERENA study) on Secukinumab for avg of ~88wks - 5.8% PsA & 8.9% AS pts had sudden stop of SEC (for avg ~25wks) (reasons? Mostly AE 58% or pt decision 10%). While TJC & SJC increased, dz control returned w/ restarting SEC

  8. Secukinumab retention in PsA: Study of 170 pts, 13% B27+, most w/ peripheral arthritis &70% on 150 mg/mo. Median retention 636 days. Peripheral arthritis was a predictor of better retention (HR 0.424).

  9. The Atlantic has published an insightful article on "Brain Fog", especially as a Long Covid consequence (IMHO: Brain fogs primary cause is poor sleep, fibromyalgia, chronic fatigue - but can be complication to primary CNS events)

  10. A longitudinal study of 506 ANCA-associated vasculitis (AAV) pts showed pts w/ negative ANCA serologies within 180 days of induction had signif lower risk of relapse (HR 0.55; 0.38 to 0.81) but not for ESRD or death within 5 years.

  11. Mayo study of 3817 temporal artery biopsies performed on 2539 pts (1994-2004) - 681 (27%) +Bx on one side. Biopsy length HAD NO significant effect BX positivity. If 1-side initially Bx-, then Bx of the contralateral side yielded an added 7% Bx positivity

  12. Immunosuppresive (IST; MMF or AZA) withdrawl in 96 stable Lupus Nephritis pts also on HCQ. After 2 years, Relapse occurred in 12.5% w/ IST continued & 27.3% with IST D/C (Not noninferior). Less Severe SLE flares (renal & extrarenal) w/ IST continuation

  13. Lupus (LUMEN) registry of 440 SLE compared to non-SLE pts, shows lupus pts have less screening for cervical cancer (HR 0.75), but SLE has more screening for HTN (HR 1.35), DM (HR 2.46), hyperlipidemia (HR 3.19) & Influenza & pneumovax vaccines

  14. Anti-CD19 CAR T cell therapy for refractory #SLE published in Nature Medicine. 5 pts (22yrs) w/ refractory dz, active SLE (SLEDAI=16). Autologous pt T cells transduced to CD19 CAR Tcells, and lead to remission in 5/5 w/in 3 mos & maintained median 8 mos


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