CAR-based cellular therapy for refractory systemic lupus erythematosus: an overlap-controlled systematic review

Area of Science:

• Immunology
• Cellular Therapy
• Rheumatology

Background:

• Systemic lupus erythematosus (SLE) is a complex autoimmune disease.
• Refractory SLE poses significant treatment challenges.
• CAR-based cellular therapy is an emerging treatment modality.

Purpose of the Study:

• To map current evidence for CAR-based cellular therapy in relapsed/refractory SLE.
• To synthesize patient-level data on safety and efficacy.
• To generate hypotheses regarding immune-reset mechanisms and platform differences.

Main Methods:

• Systematic literature search (PubMed, Embase, Web of Science) from Jan 2020-Mar 2026.
• Inclusion of studies on CAR-based therapy for relapsed, refractory, or organ-threatening SLE.
• Deduplication of overlapping reports and construction of a patient-level dataset.

Main Results:

• 21 studies with 114 patients included; predominantly young females with renal involvement.
• CD19 CAR-T and BCMA platforms were most common.
• High clinical response rates observed (e.g., 45/45), but with incomplete endpoint data; generally low-grade cytokine release syndrome and uncommon neurotoxicity.

Conclusions:

• CAR-based cellular therapy demonstrates potential as an immune-reset strategy for refractory SLE, particularly with renal disease.
• Current evidence is preliminary, uncontrolled, and incompletely reported.
• Standardized prospective studies are recommended due to limitations in data completeness and follow-up.