Axatilimab: A CSF1R-Directed Approach to Inflammation and Fibrosis

This segment offers a focused look at axatilimab, the first and only CSF1R-directed monoclonal antibody approved for chronic GVHD. Faculty explain how its mechanism differs from JAK, ROCK2, and BTK-directed agents, targeting monocyte activation and macrophage differentiation to dampen both pro-inflammatory signaling and the profibrotic drivers of disease. The discussion connects this dual action to sequencing decisions, particularly for patients with significant fibrotic features who have failed cytokine-directed therapy. Turning to the AGAVE-201 evidence, faculty highlight a strong overall response rate and, notably, meaningful improvement in patient-reported symptoms on the modified Lee symptom scale, reframing sclerotic changes as potentially reversible rather than permanent. Pulmonary function improvement and favorable infusion tolerability are emphasized, along with time to response and time to symptom improvement measured across the early doses. The segment closes on the promise of a therapy that can meaningfully change how patients feel, not only how they measure.