CAR T-cell therapy in SLE: A systematic review

CAR T-cell therapy is poised to revolutionize the treatment of SLE. Several publications reported on small numbers of SLE patients treated with CAR-T.

To review and summarize the available clinical evidence published or presented to date on the use of CAR therapy in SLE.

We conducted a systematic review to evaluate all clinical studies assessing safety and efficacy outcomes of CAR therapy in SLE. For this review, we followed PRISMA recommendations. MEDLINE (PubMed), Embase, Scopus, and CENTRAL were consulted.

The search strategy yielded 5905 results, of which 16 studies were included, encompassing 145 participants. Pooled analysis of the 102 individual SLEDAI scores available showed the mean baseline SLEDAI of 13.1 (95% CI 12.3-13.9) decreased to 2.3 (95% CI 1.5-3.1) after 6 months, and 1.4 (95% CI 0.3-2.4) after 12 months. DORIS remission was achieved in 45/64 patients (70%) and LLDAS in 50/56 (89%). CRS occurred in 81 (56%) participants, of which 80 (98%) were grade 1 or 2, and 1 (2%) grade 3. ICANS was reported in four patients, 1 grade 1, 1 grade 2, 1 grade 3, and 1 grade 4. Eleven patients (7.6%) developed serious infections, including one case of fatal pneumococcal meningitis.

This systematic review evaluated all the available clinical evidence on the use of CAR T-cell therapy in patients with SLE. The findings reinforce the efficacy of this treatment modality and underscore the need for further research to better define its role in SLE management.