Severe rheumatoid arthritis: CAR-T therapy offers new hope for a cure

A treatment already used successfully against certain blood cancers is opening up an innovative avenue for treating the most severe autoimmune rheumatic diseases, which do not respond to current therapies. We are talking about CAR-T (Chimeric Antigen Receptor T cells), which targets the cells of the immune system – specifically B lymphocytes – that mistakenly attack the patient’s own body. By eliminating them, the immune system is given the chance to ‘reset’ and – rather than merely curbing or blocking the effects of the autoimmune disease – a healthy immunological balance can be restored.

In autoimmune diseases, the body’s defence system, instead of protecting us, mistakenly attacks our own organs and tissues. Rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis and certain forms of vasculitis are among these conditions. Rheumatological conditions affect around five million people in Italia; in the most severe cases, they can cause serious damage to the joints, heart, kidneys, lungs, skin, etc. Current treatments, whether with traditional drugs (methotrexate, hydroxychloroquine, sulphapyridine, leflunomide, etc.) or more innovative ones such as biotechnological drugs and small molecules (JAKi), have so far proved to be effective and safe in the majority of patients. However, in severe rheumatoid arthritis, one in three patients does not respond adequately to conventional treatments.

CAR-T therapy involves extracting immune system cells from the patient’s blood and ‘training’ them in the laboratory to recognise and attack a specific target. The cells are then reinfused into the patient to attack and destroy the immune system cells that are mistakenly attacking the body. Once these cells have been destroyed, the immune system is completely ‘free’ of the cells responsible for the attack, thereby promoting remission of the disease.

A recent study involving 6 patients with severe rheumatoid arthritis has yielded encouraging results: 67 per cent saw the number of inflamed joints reduced by at least half, and 83 per cent showed clinical improvements after just a few weeks; after 12 months’ follow-up, three patients achieved complete, drug-free remission. The results will need to be confirmed in a larger number of patients and over a longer observation period; we specialists urge caution, not least because the observation period is short, the costs are high and the treatment requires highly specialised hospitals. However, for the most severely affected patients, who currently have no effective treatment alternatives, it represents a real hope, opening up new frontiers in the treatment of severe autoimmune rheumatic diseases.

The revolution in CAR-T cell therapies is the focus of the SIR Campania Congress, scheduled to take place in Naples on 11 and 12 September: we will also address other interesting topics such as the multidisciplinary approach to rheumatological conditions – many of which are systemic – the interaction between hospitals and the local community, and the expansion of community care homes across the region, where patients can go for treatment of conditions that are no longer in the acute phase.