Beyond malignancy, look out for LICATS with CAR-T
CD19 chimeric antigen receptor (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 https://t.co/JbTB033gti
Dr. John Cush @RheumNow( View Tweet )
Taking a closer look: B-Cell depletion beyond the blood
At #ACR25, we have seen an exciting wave of cellular and immune therapies reshaping the landscape of autoimmune disease treatment. Following the landmark case series by the Erlangen group, multiple cellular therapies have https://t.co/GIrPwlGKE2
Dr. John Cush @RheumNow( View Tweet )
Having #RA does not increase mortality in CA pts Rx w/ immune checkpoint inhibitors (ICI). 301 Veterans w/ RA & 2114 nonRA controls were compared: all-cause mortality was similar (HR 1.09; 0.94, 1.25). Most deaths from cancer (90% & 91%), but rarely from infection (<1%) https://t.co/gsXie6HpTu
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
Dr. John Cush @RheumNow( View Tweet )
S.Korean study of 481 pts w/ myositis (IIM) - 12.9% (n = 62) had myositis-assoc. cancer. CA risk factos= older age, male, current smoking, dermatomyositis, TIF1γ; but lower risk w/ anti-synthetase synd, overlap myositis, arthritis, & ILD. SCRIM score had AUROC = 0.852 https://t.co/MdU1fRWWgS
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
Dr. John Cush @RheumNow( View Tweet )
Beyond the Breakthrough: Equity and Access in CAR-T Cell Therapy for RA
At #ACR25, abstract 1039, "Global Cost-Effectiveness and Equity in CAR-T Cell Therapy for Rheumatoid Arthritis," highlights the critical economic and ethical dimensions of CAR-T cell therapy in autoimmune https://t.co/Rci0dL7THj
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 )
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
Links:
Janet Pope @Janetbirdope( 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
Links:
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 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 )
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 )
Dr. John Stone on IgG4RD
⬆️ common in males
⬆️internal organ involvement
🔸Mimics cancer
🔸Indolence makes it dangerous —-> organ complications
Diagnosis highly dependent on the rheumatologist based on clinical features, serologies, imaging & pathological data
#ACR25 @Rheumnow https://t.co/St4EbA7Dcj
sheila @RHEUMarampa( View Tweet )
#ACR25 Abstr#LB14 Deep blood & tissue depletion are not just confined to CAR-T. Exploratory analysis of REGENCY showed Obinutuzumab induced near-complete depletion & significantly reduced plasma in kidney tissue vs PBO @RheumNow https://t.co/r1danWBM7D
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
After melanoma, should RA patients stop DMARDs?
These VA data (n=644) showed no mortality signal, and trending to survival benefit with b/tsDMARDs
Provisos over methotrexate, invasive disease etc, but don’t hold off treating the RA because of melanoma
#ACR25 ABST2237 @RheumNow https://t.co/l9n1V6YVln
David Liew @drdavidliew( View Tweet )
MSK side effects of CAR-T, based on FAERS pharmacovigilance data (also see @DrGomezPuerta in @seminarthrheum https://t.co/LnwjU5aebs) #ACR25 ABST1731 @RheumNow https://t.co/kREEy3HLE9
Links:
David Liew @drdavidliew( View Tweet )
Girolami et al. VA study. Safety of DMARDs in RA following melanoma. 644 patients. 3 year all cause mortality. No significant difference, but graph sure looks like b/tsDMARDs are better. No melanoma specific mortality/recurrence data however. @RheumNow #ACR25 Abstr#2237 #ACRBest https://t.co/IN4LDkioT7
Richard Conway @RichardPAConway( View Tweet )
#ClinicalPearl
Pts w #SpA ex #PsA May have
👇
#sicca #dry #eyes #dry mouth
Inflamed gallbladder without calculi
👇
Can be associated w #autoimmune disease
#POTS can be initial presentation of #SjD
IgA vasculitis—May have #cancer
#Secrets & #Pearls #ACR25 @RheumNow @ACRheum https://t.co/4SAqVYjnrD
Janet Pope @Janetbirdope( View Tweet )
#1726 IA from immune checkpoint inhibitors (ICI) is a distinct autoimmune entity: T cell-driven but not antibody-mediated
irAE arthritis shows hyperactive, cytotoxic CD8+ T cells & metabolic reprogramming, unlike RA. IL-6, IL-12 & IFNα fuel this process. @RheumNow #ACR25
Mrinalini Dey @DrMiniDey( View Tweet )
Abstract 1718: Immune checkpoint inhibitors (ICI) in pre-existing #SLE
Compared to non-SLE pts, those with SLE receiving ICIs had:
🔹 ↑ risk of thrombocytopenia & pancytopenia
🔹 No significant difference in all-cause mortality
@RheumNow #ACR25 https://t.co/N1iOvxbsAZ
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
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