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Blache U, Tretbar S, Koehl U, Mougiakakos D, Fricke S. CAR T cells for treating autoimmune diseases. RMD Open 2023; 9:e002907. [PMID: 37996128 PMCID: PMC10668249 DOI: 10.1136/rmdopen-2022-002907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/18/2023] [Indexed: 11/25/2023] Open
Abstract
Autoimmune disorders occur when immune cells go wrong and attack the body's own tissues. Currently, autoimmune disorders are largely treated by broad immunosuppressive agents and blocking antibodies, which can manage the diseases but often are not curative. Thus, there is an urgent need for advanced therapies for patients suffering from severe and refractory autoimmune diseases, and researchers have considered cell therapy as potentially curative approach for several decades. In the wake of its success in cancer therapy, adoptive transfer of engineered T cells modified with chimeric antigen receptors (CAR) for target recognition could now become a therapeutic option for some autoimmune diseases. Here, we review the ongoing developments with CAR T cells in the field of autoimmune disorders. We will cover first clinical results of applying anti-CD19 and anti-B cell maturation antigen CAR T cells for B cell elimination in systemic lupus erythematosus, refractory antisynthetase syndrome and myasthenia gravis, respectively. Furthermore, in preclinical models, researchers have also developed chimeric autoantibody receptor T cells that can eliminate individual B cell clones producing specific autoantibodies, and regulatory CAR T cells that do not eliminate autoreactive immune cells but dampen their wrong activation. Finally, we will address safety and manufacturing aspects for CAR T cells and discuss mRNA technologies and automation concepts for ensuring the future availability of safe and efficient CAR T cell products.
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Affiliation(s)
- Ulrich Blache
- Fraunhofer Institute for Cell Therapy and Immunology IZI, Leipzig, Germany
- Fraunhofer Cluster of Excellence for Immune-Mediated Disease, Leipzig, Germany
| | - Sandy Tretbar
- Fraunhofer Institute for Cell Therapy and Immunology IZI, Leipzig, Germany
- Fraunhofer Cluster of Excellence for Immune-Mediated Disease, Leipzig, Germany
| | - Ulrike Koehl
- Fraunhofer Institute for Cell Therapy and Immunology IZI, Leipzig, Germany
- Fraunhofer Cluster of Excellence for Immune-Mediated Disease, Leipzig, Germany
- University of Leipzig Faculty of Medicine, Leipzig, Germany
| | | | - Stephan Fricke
- Fraunhofer Institute for Cell Therapy and Immunology IZI, Leipzig, Germany
- Fraunhofer Cluster of Excellence for Immune-Mediated Disease, Leipzig, Germany
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CAR-T cell therapy in India requires a paradigm shift in training, education and health care processes. Cytotherapy 2021; 24:101-109. [PMID: 34753677 DOI: 10.1016/j.jcyt.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022]
Abstract
Chimeric antigen receptor (CAR)-T cell therapy has revolutionized the treatment of some kinds of cancers. Hundreds of companies and academic institutions are collaborating to develop gene-modified cell therapies using novel targets, different cell types, and manufacturing processes of autologous and allogenic cell therapies. The individualized, custom-made autologous CAR-T cell production platform remains a significant limiting factor for its large-scale clinical application. In this respect, the advances in standardization and automation of the process can have considerable impact on cost reduction. Development of off-the-shelf, ready-to-use universal killer cells can enable scaling up. Despite the wide use of this cell therapy in the United States, Europe and China, its development is limited in developing countries in Southeast Asia, Africa and Latin America. In this review, we focus on good manufacturing practices-compliant manufacturing requirements, operational logistics, and regulatory processes that need to be considered for high-quality gene-modified cell therapies from an Indian perspective. We also list the potential strategies to overcome challenges associated with translation to affordability and scalability.
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Raimond V, Kaltenbach E, Adam C, Lazzarotto S, Le Galès C, Perrier L, Wittwer J. Challenges raised by the economic evaluation of CAR-T-cell therapies. The review by the French National Authority for Health. Bull Cancer 2021; 108:1162-1169. [PMID: 34629167 DOI: 10.1016/j.bulcan.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Abstract
Since 2013, the process of pricing of innovative drugs by the French National Health Insurance has considered both cost-effectiveness and budget impact. CAR-T cell therapies were first subject to economic evaluation from 2019 in France. We aim to describe the process and results of the economic evaluation of tisagenlecleucel and axicabtagene ciloleucel as well as the challenges these evaluations raised. Evaluations submitted by the firms were reviewed by HAS and submitted to the Committee of Economic Evaluation and Public Health (CEESP). The CEESP issued opinions related to: (1) the methodological quality of economic evidence and, (2) the cost-effectiveness and budget impact of the drugs. The CEESP invalidated the estimated incremental cost-utility ratios (ICUR) of tisagenlecleucel due to the insufficient clinical evidence and methodological quality to extrapolate the long-term progression of the disease after treatment and compare tisagenlecleucel with alternatives. The CEESP concluded that tisagenlecleucel was not proven cost-effective. The estimated ICUR of axicabtagene ciloleucel at €114,509/QALY vs. chemotherapies was associated with an acceptable level of methodological quality despite being based on a weak indirect comparison and limited data on quality of life. The CEESP considered axicabtagene ciloleucel ICUR to be "very high" and questioned the societal/community willingness-to-pay of the claimed price. The primary source of uncertainty surrounding the ICUR estimates of both drugs was the lack of hindsight on effectiveness. The economic evaluation of CAR-T cell therapies highlights the risk of inefficient resource allocation driven by limited clinical data. It calls for payment schemes accounting for this risk and effective collection of post-marketing data.
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Affiliation(s)
- Véronique Raimond
- Haute Autorité de santé, Départment of Economic and Public Health Evaluation, 5, avenue du Stade de France, 93210 Saint-Denis, France.
| | - Emmanuelle Kaltenbach
- Haute Autorité de santé, Départment of Economic and Public Health Evaluation, 5, avenue du Stade de France, 93210 Saint-Denis, France
| | - Christophe Adam
- University of Bordeaux, Department of General Practice, 146, rue Léo Saignat, 33000 Bordeaux, France; Haute Autorité de santé, Committee for Economic and Public Health Evaluation, 5, avenue du Stade de France, 93210 Saint-Denis, France
| | - Sébastien Lazzarotto
- Aix-Marseille University, Health Service Research and Quality of Life Center-EA 3279, CEReSS, 27, boulevard Jean Moulin, 13005 Marseille, France; Haute Autorité de santé, Committee for Economic and Public Health Evaluation, 5, avenue du Stade de France, 93210 Saint-Denis, France
| | - Catherine Le Galès
- Université de Paris, Cermes 3, CNRS UMR 8211, EHESS Inserm U 988, 7, rue Guy Môquet, BP 8, 94801 Villejuif cedex, France; Haute Autorité de santé, Committee for Economic and Public Health Evaluation, 5, avenue du Stade de France, 93210 Saint-Denis, France
| | - Lionel Perrier
- Université Centre Léon-érard, GATE L-SE UMR 5824, 69008 Lyon, France; Haute Autorité de santé, Committee for Economic and Public Health Evaluation, 5, avenue du Stade de France, 93210 Saint-Denis, France
| | - Jérôme Wittwer
- Université de Bordeaux, Bordeaux Population Health, Inserm U1219, 146, rue Léo Saignat, 33000 Bordeaux, France; Haute Autorité de santé, Committee for Economic and Public Health Evaluation, 5, avenue du Stade de France, 93210 Saint-Denis, France
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Huguet M, Raimond V, Kaltenbach E, Augusto V, Perrier L. How much does the hospital stay for infusion of anti-CD19 CAR-T cells cost to the French National Health Insurance? Bull Cancer 2021; 108:1170-1180. [PMID: 34561025 DOI: 10.1016/j.bulcan.2021.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/04/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022]
Abstract
Chimeric antigen receptor T-cells (CAR-T cells) have the potential to be a major innovation as a new type of cancer treatment, but are associated with extremely high prices and a high level of uncertainty. This study aims to assess the cost of the hospital stay for the administration of anti-CD19 CAR-T cells in France. Data were collected from the French Medical Information Systems Program (PMSI) and all hospital stays associated with an administrated drug encoded 9439938 (tisagenlecleucel, Kymriah®) or 9440456 (axicabtagene ciloleucel, Yescarta®) between January 2019 and December 2020 were included. 485 hospital stays associated with an injection of anti-CD19 CAR-T cells were identified, of which 44 (9%), 139 (28.7%), and 302 (62.3%) were for tisagenlecleucel in acute lymphoblastic leukaemia (ALL), tisagenlecleucel in diffuse large B-cell lymphoma (DLBCL), and axicabtagene ciloleucel respectively. The lengths of the stays were 37.9, 23.8, and 25.9 days for tisagenlecleucel in ALL, tisagenlecleucel in DLBCL, and axicabtagene ciloleucel, respectively. The mean costs per hospital stay were € 372,400 for a tisagenlecleucel in ALL, € 342,903 for tisagenlecleucel in DLBCL, and € 366,562 for axicabtagene ciloleucel. CAR T-cells represented more than 80% of these costs. n=13 hospitals performed CAR-T cell injections, with two hospitals accounting for more than 50% of the total number of injections. This study provides original data in a context of limited information regarding the costs of hospitalization for patients undergoing CAR-T cell treatments. In addition to the financial burden, distance may also be an important barrier for accessing CAR T-cell treatment.
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Affiliation(s)
- Marius Huguet
- Mines Saint-Étienne, université Clermont-Auvergne, CNRS, UMR 6158 LIMOS, Centre CIS, 42023 Saint-Étienne, France; Université Lyon, centre Léon-Bérard, GATE L-SE UMR 5824, 69008 Lyon, France
| | - Véronique Raimond
- Haute Autorité de santé, Department of Economic and Public Health Evaluation, 93200 Saint Denis, France
| | - Emmanuelle Kaltenbach
- Haute Autorité de santé, Department of Economic and Public Health Evaluation, 93200 Saint Denis, France
| | - Vincent Augusto
- Mines Saint-Étienne, université Clermont-Auvergne, CNRS, UMR 6158 LIMOS, Centre CIS, 42023 Saint-Étienne, France
| | - Lionel Perrier
- Université Lyon, centre Léon-Bérard, GATE L-SE UMR 5824, 69008 Lyon, France; Human and Social Science Department, centre Léon-Bérard, 69008 Lyon, France; Haute Autorité de santé, Committee for Economic and Public Health Evaluation, 93200 Saint Denis, France.
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