Barriers to CAR T-cell therapy in rheumatology

Lancet Rheumatol 2024 doi: 10.1016/S2665-9913(24)00240-6

Lungova et al. explored the potential of CAR T-cell therapy in autoimmune conditions such as SLE, myopathies, and systemic sclerosis. While clinical cases show promise, adoption is limited by high costs, narrow patient eligibility, and safety concerns, including cytokine release syndrome. Future targeted CAR T-cell approaches may enhance efficacy and safety.

Heutz et al. found that patients requiring bDMARDs rarely achieved DMARD-free remission, while 15–37% of those on non-bDMARDs reached this milestone, underscoring significant differences based on treatment type. This suggests the EULAR recommendation against DMARD cessation may be too generalised.

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December 2024

Alarfaj et al. demonstrate fenofibrate significantly improved clinical outcomes, inflammatory biomarkers, and quality of life in patients with mild-to-moderate UC when added to mesalamine therapy.

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Renkhold et al. report that secukinumab significantly reduced psoriasis-associated pruritus intensity, improved skin lesions, and normalised histopathological changes, with stable neuroanatomy despite treatment discontinuation.

Baraliakos et al. assessed the long-term efficacy and safety of upadacitinib in patients with active ankylosing spondylitis who were refractory to biologic therapy. At week 104, the treatment sustained improvements in disease activity and functional outcomes with low rates of radiographic progression and no new safety signals.

Kavanaugh et al. conducted a post hoc analysis of a phase 2 trial examining deucravacitinib in patients with active psoriatic arthritis, focusing on the achievement of MDA components.

The analysis demonstrated that treatment with deucravacitinib led to a higher proportion of patients meeting each MDA component compared with placebo at 16 weeks.

Østergaard et al. conducted a phase 4 multicentre, single-arm, open-label study to evaluate the effect of apremilast on MRI-assessed inflammation in PsA patients using PsAMRIS and MRI-WIPE. The study demonstrated that apremilast reduced inflammation in joints and entheses with no structural damage progression. The study also supports the use of MRI as an objective tool in PsA trials.

Haraoui et al. conducted a subgroup analysis of the CANTORAL study, showing that tofacitinib effectiveness was similar in patients with or without CV risk enrichment. However, AEs, particularly in older patients (≥65 years), were more frequent in the CV+ cohort. These findings highlight the need for tailored CV risk management when treating RA with tofacitinib.

Buch et al. demonstrated that filgotinib sustained its efficacy in rheumatoid arthritis patients through Wk156 in the FINCH 4 long-term extension study, showing stable safety profiles. The study reported high ACR response rates and remission based on Boolean criteria, underlining filgotinib's potential for extended clinical benefits.

Baricitinib as monotherapy for treatment of rheumatoid arthritis: analysis of real-world data

Current Medical Research and Opinion 2024;40:1993–2002 doi: 10.1080/03007995.2024.2416979.

Edwards et al. report on real-world data for baricitinib monotherapy in rheumatoid arthritis, showing significant disease activity reduction across multiple registries and observational studies. These findings reinforce the viability of baricitinib monotherapy in clinical practice for RA patients, complementing existing guidelines.