News in brief: CAR-T shows promise in severe lupus; Nailfold capillaroscopy underused to diagnose systemic sclerosis; Injectable hydrogel for degenerative disc disease

Thursday, 23 Jun 2022

CAR-T shows promise in severe lupus

CAR T-cell therapy was well-tolerated and induced rapid disease remission in a small group of patients with severe, refractory systemic lupus erythematosus (SLE), a study presented at EULAR 2022 has shown.

The research assessed CD19 CAR T-cell therapy in five patients with severe SLE and active kidney disease.

According to Professor Georg Schett, Director of the Rheumatology and Immunology Clinic at Friedrich-Alexander University in Germany, the first patient to receive the therapy (a 20 year-old female) experienced sustained drug-free remission with complete loss of ANA and dsDNA antibodies, despite reemergence of B cells after six months.

After three months’ treatment, SLEDAI scores dropped to remission in all 5 patients receiving CAR T-cell therapy, he said.

The results so far show that complement factor 3 and 4 were normalised for the first time, and that there was a fast decrease in proteinuria with complete resolution after 30 days, he told delegates.

And the latest update, which includes longer-term data (400 days) from at least two patients, show that while B cell depletion lasted for around 100 days before re-emergence, patients remained in remission and were treatment free.

Prof Schett also noted that safety and toxicity of the therapy is “outstanding”, with no serious grade adverse events including cytokine release syndrome.

All in all, the data show “feasibility (apheresis, expansion and reinfusion) of CAR T-cell therapy in autoimmune disease, rapid and sustained clearance of B cells from circulation, clearance of anti-dsDNA antibodies and normalisation of complement levels and normalisation of protein excretion in the urine and remission of SLE”, he said.

Nailfold capillaroscopy underused to diagnose systemic sclerosis

Research has revealed varied use of nailfold capillaroscopy as a diagnostic tool for systemic sclerosis, indicating that its benefits are not being fully realised.

An online survey sent to 104 rheumatologists showed “wide variations” in UK clinical practice, with just over a third (33%) reporting on-site use of nailfold capillaroscopy in patients presenting with Raynaud’s phenomenon, and just under a third (27%) reporting not using the tool at all.

A lack of equipment (85%), experience in acquiring images (69%) and expertise in interpreting images (67%) were cited by respondents as key barriers.

“Increased uptake of nailfold capillaroscopy across the UK would realise patient benefits in terms of health gain through early detection (through appropriate monitoring) and treatment of internal organ involvement, and could also improve the overall patient experience beyond these anticipated health gains,” the authors said in the paper published in Rheumatology.

The research also revealed appetite among rheumatologists for the development of a standardised, internet-based, automated system to improve use of the diagnostic tool, with  63% of respondents voiced interest in such a system for reporting images, which “could help increase uptake of capillaroscopy and thereby facilitate early diagnosis of systemic sclerosis across the UK”, they added.

Injectable hydrogel relieves low back pain caused by degenerative disc disease

A novel formulation of a hydrogel that can be injected into spinal discs proved safe and effective in relieving chronic low back pain caused by degenerative disc disease (DDD), according to new research to be presented at the recent Society of Interventional Radiology Annual Scientific Meeting in the US.

The first human study of Hydrafil, a second-generation FDA ‘breakthrough device’ hydrogel enrolled 20 patients, with chronic DDD low back pain.

After six months, all participants reported significantly less low back pain—declining from an average self-reported pain level of 7.1 down to 2.0 on a scale of zero to 10. They also experienced greatly improved physical function, with average function scores falling from 48 to 6 on a questionnaire.

Study investigator Dr Douglas Beall, chief of radiology services at Clinical Radiology of Oklahoma, said he gel was heated to become a thick liquid and then injected . guided by fluoroscopic imaging, directly into the affected discs, where it filled in cracks and tears, adhering to the disc’s centre and outer layer.

“We really have no good treatments for degenerative disc disease, aside from conservative care,” said Dr Beall. “Surgery is statistically no more effective than conservative care and can potentially make things worse; nerve ablation is appropriate for only a few patients; and existing hydrogels are inserted through an incision as a soft solid, which can pop out of place if you’re not highly skilled in placing it.”

“Because this gel is injectable, it requires no incision, and it augments the whole disc, restoring its structural integrity, which nothing we have currently can do,” he said.


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