Drug-resistant RA Does Blinatumomab BiTE? Save

Hello, everyone. My name is Youssef. I am a consultant rheumatologist from Leeds, United Kingdom. Today, I'm reporting for RheumNow at the twenty twenty four EULA Congress in Vienna. This conference, there have been many stories, about progression of CAR T cells therapy in SLE and also other autoimmune diseases.

However, watch out. There's one more interesting therapy that will coming at you very shortly. So this is an abstract OP093. So this compound is called BITE or blinatumomab. So BiTE stands for bispecific T cell engagers.

So as we all know that B cells play a major role in the pathogenesis of rheumatoid arthritis, systemic lupus and also other autoimmune diseases. Therefore, targeting B cells have been mostly evaluated over the last fifteen years. What we know as well, that the degree of B cell depletion through anti CD20 monoclonal antibodies is associated with clinical response. So, in this study, it's looking at a different strategy, to cause profound B cell depletion, both in the blood and in the tissue. So essentially, this mechanism called bispecific T cell engagers, has been evaluated in haematological malignancies such as acute lymphoblastic leukemia.

So, this work was the first in human, in patients with rheumatic diseases, namely the rheumatoid arthritis. So, what this group did was they look into six patients with rheumatoid arthritis. So, all of them, had severe refractory diseases, as defined by failure, two, three, either target synthetic or biological DMARDs. So what, the principle of, this, BITE, was that, the molecules, can engage, two cells, One, on the CD19 on the B cells, and also one, on the CD3 T cells. So when this engagement occurs, the T cells, will then, cause the B cell killing and cause apoptotic death of the cells.

So again, using T cells, as a killer here. So in terms of, the treatment, how is it given? So basically, this is a monoclonal antibodies. So patient needed to stop their biological treatment at least three months before. So then after that they need to be hospitalised for five days, especially because this was a first inhuman.

They infuse very slowly within five days and after that they administer another one five days as well. So it's two infusion. And what, they found in terms of safety profile, there was a very mild, slight increased body temperature, but there's no other signs of cytokine storm. And what they also found that in terms of a safety perspective, there was slight increase in the CRP level for the first couple of days, then after that it normalized. So in terms of efficacy, so all these patients responded in terms of reduction, significant reduction of DAS28 score from baseline and also all the changes of musculoskeletal ultrasound improved.

And interestingly as well, they also did some synovial biopsy which confirm there's also tissue depletion here and also restoration of the aberrant B cells. So, this is really an exciting therapeutic target. And findings have been published in the Nature Medicines two months ago, if you want to have a look in more detail, but certainly something that we will look forward to for those people with refractory diseases. So this applied to RA, but will likely knocking our door for other diseases such as systemic lupus, Sjogren's and myositis and etc. One thing that may be quite favourable is potentially due to the cost because the cost is estimated around $76,000 to $100,000 whereas the CAR T cell therapy somewhere around the ballpark of $300,000 to $500,000 And so maybe it will be good as well to look head to head trial between these two treatments.

Okay, I hope you found my summary useful. Please follow me in the room now on various social media outlets including Twitter and YouTube for more coverage of the Congress content. Bye bye.