30-Second Takeaway
- TNF inhibitor or methotrexate tapering in RA is risky outside of strict remission, but may be feasible in deep remission.
- High-dose folic acid (≥5 mg/day) with methotrexate in RA is linked to higher major cardiovascular event risk than lower doses.
- CD19 CAR‑T cells can induce prolonged drug‑free remission in severe refractory rheumatic disease, with much milder toxicity than in oncology.
- Very early axial spondyloarthritis does not show superior TNF inhibitor response or drug survival compared with established disease.
- Biologics in EGPA reduce steroid exposure and relapses; comorbidities in SLE and RA substantially affect targets, damage, and malignancy risk.
Week ending March 7, 2026
What’s new in inflammatory rheumatic disease management: tapering, comorbidities, biologics, and emerging cell therapies
TNF inhibitor spacing or methotrexate reduction in RA remission: noninferior only in strict remission
In this open-label RCT, RA patients with CDAI remission or low disease activity on ozoralizumab plus methotrexate were randomized to continue, space TNF inhibitor, or reduce methotrexate. At 48 weeks, low disease activity was maintained in 97.9% of continuers, 79.2% with TNF inhibitor spacing, and 72.7% with methotrexate reduction, missing noninferiority. Among patients in baseline remission, remission maintenance rates were similar across groups, suggesting tapering is safer in deep remission than in low activity. HAQ-DI, radiographic progression, and adverse events were comparable, indicating functional and structural outcomes were preserved despite more flares with tapering.
High-dose folic acid with methotrexate in RA linked to higher MACE risk
This population-based cohort included 8405 Hong Kong RA patients on methotrexate without baseline major cardiovascular events. About 35% received ≥5 mg/day folic acid and 65% received lower doses, with median follow-up of 9 years. High-dose folic acid (≥5 mg/day) was associated with increased MACE risk versus lower doses (adjusted HR 1.34–1.39 across models). The association persisted after extensive adjustment, inverse probability weighting, and machine-learning methods, suggesting high-dose folate may adversely influence cardiovascular risk in methotrexate-treated RA.
CD19 CAR-T therapy yields durable, drug-free remission in severe refractory rheumatic disease
This systematic review summarized 12 studies including 44 patients with severe, treatment-refractory rheumatic autoimmune diseases given CAR-T therapy. Most constructs were CD19-targeted, in patients previously exposed to multiple conventional and biologic agents. Clinical responses were universal, with individual study response rates of 92–100% and complete responses within 2–16 weeks. Drug-free remissions persisted 6–46 months, with substantial autoantibody reductions of 80–99% across disease-specific markers. Toxicity was favorable: cytokine release syndrome was limited to grades 1–2, with no grade ≥3 events and predominantly mild neurotoxicity.
TNF inhibitors in very early versus established axial spondyloarthritis show similar effectiveness
Using 3324 axSpA patients from the Swiss SCQM registry, this study compared TNF inhibitor effectiveness by back pain duration. Very early disease (≤1 year back pain) was contrasted with early (>1–≤2 years) and established (>2 years) axSpA at first TNF inhibitor start. After multivariable adjustment, odds of achieving ASDAS <2.1 at 1 year did not differ between very early and established disease (OR 1.08, 95% CI 0.70–1.68). TNF inhibitor drug survival was also similar (HR for discontinuation 1.05, 95% CI 0.84–1.31), providing no evidence of a TNF “window of opportunity” defined by very early symptoms.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.