The Future of SLE Treatment?

“I think we are living in a very exciting time for patients with severe autoimmune diseases,” Dr. Schett said.

Looking Forward

More than ten different B cell depleting CAR T cell therapies are slated for clinical trials in patients with SLE. These trials have either already started or should begin soon.² Also, trials should start soon in patients with systemic sclerosis and myositis. Theoretically, this treatment approach may also be effective in other rheumatic diseases, such as rheumatoid arthritis.⁶

Interestingly, Dr. Schett’s patients have all been young (age 18–33), but trials such as Novartis’ SLE CAR T cell trial are planning to enroll a broader range of patients (18–65). This approach may affect treatment response or the risk of toxicities.²

Even if scientists eventually demonstrate the safety and efficacy of these therapies in large clinical trials, the implementation hurdles will remain high. Current FDA-approved CAR T cell therapies for blood cancers cost $300,000–500,000, so many patients will face major access challenges.²

Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.

References

1. Mackensen A, Müller F, Mougiakakos D, et al. Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus. Nat Med. 2022 Oct;28(10):2124–2132.
2. Mullard A. CAR T cell therapies raise hopes—and questions—for lupus and autoimmune disease. Nat Rev Drug Discov. 2023 Nov;22(11):859–861.
3. Taubmann J, Müller F, Boeltz S. Long term safety and efficacy of CAR-T cell treatment in refractory systemic lupus erythematosus—data from the first seven patients. Ann Rheum Dis. 2023;82(S1):93–94
4. Bergmann C, Müller F, Distler JHW, et al. Treatment of a patient with severe systemic sclerosis (SSc) using CD19-targeted CAR T cells. Ann Rheum Dis. 2023 Aug;82(8):1117–1120.
5. Müller F, Boeltz S, Knitza J, et al. CD19-targeted CAR T cells in refractory antisynthetase syndrome. Lancet. 2023 Mar 11;401(10379):815–818.
6. Schett G, Mackensen A, Mougiakakos D. CAR T-cell therapy in autoimmune diseases. Lancet. 2023 Nov 25;402(10416):2034–2044.
7. Anolik JH, Barnard J, Owen T, et al. Delayed memory B cell recovery in peripheral blood and lymphoid tissue in systemic lupus erythematosus after B cell depletion therapy. Arthritis Rheum. 2007 Sep;56(9):3044–3056.