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By Nancy Lapid, Health Science Editor

Hello Health Rounds readers! Today we have some exciting early data showing that CAR-T therapy currently used to treat cancer may also treat serious autoimmune diseases such as lupus. Another pair of studies in the field of immunology found that an older rheumatoid arthritis drug may be able to prevent the disease in those at high risk. And we feature yet another study highlighting racial disparities in healthcare, in this case a common tool used to test blood oxygen that may make it harder for Black patients to get care for advanced heart failure. 

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Doctors have long known that pulse oximeters are less accurate in estimating blood oxygen levels in non-white patients. A new study shows pulse oximeter miscalculations in Black patients with heart failure could mistakenly keep them from getting advanced treatments such as heart transplantation. Scroll down to read more. REUTERS/Afolabi Sotunde.

A cancer treatment known as chimeric antigen receptor (CAR) T cells might also be useful for treating autoimmune diseases in which the immune system mistakenly attacks healthy parts of the body, according to a study of 15 patients published on Wednesday in The New England Journal of Medicine.

All of the patients had severe autoimmune diseases attacking their tissues such as systemic lupus erythematosus, idiopathic myositis, or systemic sclerosis. Each patient received a single infusion of CAR T cells targeted at a molecule on B cells called CD19.

During follow up ranging from four to 29 months, with a  median of 15 months, all were in remission or had major reductions in symptoms and had discontinued all immunosuppressive and anti-inflammatory medication, researchers reported.

Toxic effects of the CAR T infusions were mostly mild, they said.

“Even though it is premature to judge whether these patients are indeed cured from their autoimmune disease, CD19 CAR T cells at least appear to be able to achieve sustained disease- and drug-free remission,” the researchers said.

An editorial published with the study called the results “remarkable” but cautioned that much work is needed to prove the value and safety of CAR T cell therapy for autoimmune diseases.

In January, responding to reports of patients developing secondary cancers after being treated with CAR-T therapies, the U.S. Food and Drug Administration asked drugmakers to add a serious warning on labels of cancer therapies that use CAR-T technology.

A drug approved for treating rheumatoid arthritis (RA) might also prevent or delay onset of the disease in high-risk individuals, two proof-of-concept trials suggest.

In a UK trial published in The Lancet, the estimated proportion of participants remaining RA-free after a year of weekly treatments with Bristol Myers Squibb’s Orencia (abatacept) was 92.8%, versus 69.2% in those who received a placebo.

A year after the treatment was stopped, RA had developed in 25% of those who received abatacept and in 37% of those in the placebo group.

The 213 study volunteers all had severe joint pain and antibodies typically found in the blood before RA is diagnosed, but they did not have full-blown disease. “The risk for developing RA within a short time is high” in such individuals, the study team said.

Orencia was also associated with improvements in pain scores, function and quality of life measurements, and early signs of joint and tendon inflammation.

In a separate trial conducted at 14 hospitals in Europe, 100 similar high-risk patients received abatacept or placebo for six months.

The proportion of participants with improved signs of inflammation at the end of the treatment period was 57% in the abatacept group and 31% for the placebo group, researchers reported in The Lancet.

A year after treatment stopped, improvement in inflammation was seen in 51% in the abatacept group versus 24% for placebo, while 35% in the drug group and 57% in the placebo group had developed RA, the researchers said.

The two papers “present the most positive data published to date in the pre-RA field,” according to an editorial published with the reports.

Longer follow-up is needed to see whether the differences between the groups persist, and whether use of abatacept to delay progression would be cost-effective, the editorial said.

Inaccurate estimates of blood oxygen levels by tools originally calibrated for white skin may be limiting Black patients’ access to heart transplants and other treatments for end-stage heart failure, researchers say.

In a review of data from 204 adult heart failure patients treated in one medical center’s intensive care units between 2016 and late 2022, researchers found that pulse oximeters – devices placed on a finger to estimate blood oxygen levels – underestimated how much blood was pumping out of Black patients’ hearts and overestimated the resistance in their blood vessels, making them appear to be less ill than they were.

“In addition to possibly precluding Black patients from being candidates for heart transplants or left ventricular assist devices (LVADs),” which assist the heart in pumping, “these inaccurate measurements could result in the unnecessary use of medications that affect heart and vessel function,” Dr. Matthew Konerman of the University of Michigan’s Frankel Cardiovascular Center , co-author of a report published in Circulation – Cardiovascular Quality and Outcomes, said in a statement.

Pulse oximeters are known to be less accurate on darker skin, but they are commonly used as an alternative to the painful procedure required to directly measure oxygen levels in arterial blood.

On Feb. 2, the U.S. Food and Drug Administration held a public advisory committee meeting to discuss approaches to improving the performance of pulse oximeters with respect to skin pigmentation, race and ethnicity.

When managing Black patients with heart failure, doctors should either measure oxygen saturation directly from the blood or use other methods to assess their cardiovascular and blood flow status, the researchers said.

“Black patients are already less likely to receive heart pumps or transplants compared to their white counterparts, and these inaccurate readings can further widen a disparity that must be addressed by our healthcare system,” study leader Dr. Scott Ketcham of University of Michigan Health said in a statement.

Read more about pulse oximeters on Reuters.com

• Wanted: an oxygen monitor reliable for all races.

This newsletter was edited by Bill Berkrot. Additional reporting by Shawana Alleyne-Morris.

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