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.

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.

Choy et al. investigated the efficacy and safety of intensified versus standard infliximab dosing for steroid-refractory acute severe ulcerative colitis (ASUC). The study found that a first dose of 10mg/kg infliximab was not superior to the standard 5mg/kg dose in achieving clinical response by Day 7. Earlier responses were noted with dose intensification, but no significant differences were observed in remission, colectomy rates, or safety profiles by Month 3.

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October 2024

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.

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.

September 2024

Ghani et al. compared the efficacy and safety profiles of tapinarof and roflumilast for treating mild-to-moderate plaque psoriasis. Both therapies showed robust efficacy and were well-tolerated, with low rates of adverse events. Tapinarof exhibited marginally higher efficacy in PASI scores compared to roflumilast.

Cai et al. demonstrated that xeligekimab significantly improved the Psoriasis Area and Severity Index (PASI) scores in patients with moderate-to-severe plaque psoriasis, with 90.7% achieving PASI 75 at week 12. Xeligekimab was well-tolerated with no unexpected safety concerns.

Deodhar et al. evaluated the efficacy and safety of intravenous secukinumab in patients with active axial spondyloarthritis. The study found a significant improvement in the ASAS40 response at Week 16 (40.9% vs 22.9% in placebo, P<0.0001), with responses maintained through Week 52. No new safety signals were observed.

IV secukinumab provided rapid and sustained improvements in disease signs and symptoms at Week 16 and through 52 weeks. Kivitz et al. evaluated the long-term efficacy, safety, and tolerability of IV secukinumab in patients with active PsA.

Buch et al. evaluated the efficacy and safety of filgotinib in patients with moderately active rheumatoid arthritis and inadequate response to methotrexate in the FINCH 1 study. At     Wk 12, ACR20 response rates were significantly higher with filgotinib 200 mg (77.9%) and 100 mg (67.8%) compared to placebo (43.8%). Safety profiles for both filgotinib doses were similar to adalimumab.