Rheumatologists' expectations and perceptions of T-cell redirecting therapies: results from a cross-sectional survey

T-cell redirecting therapies (TCRTs), including Chimeric antigen receptor (CAR)-T cells and T-cell engagers (TCEs), are emerging as transformative treatments for autoimmune diseases. However, clinical application is currently restricted to specialized centers, leaving most clinicians with limited first-hand experience. We aimed to assess the knowledge, perception, and barriers regarding TCRTs among German rheumatologists. A prospective, web-based survey was distributed to German rheumatologists via congresses and digital channels from September 2024 through January 2025. Drafting the design and reporting of the survey results was performed regarding international recommendations as the "checklist for reporting results of internet e-surveys" (CHERRIES). Statistical analysis was conducted with SPSS. Of 98 participants (median age 43 years) the majority was based at university hospitals (46.3%) and 94.8% were willing to refer patients to specialized centers. However, respondents considered only 5% of their patients suitable for TCRT, primarily those with severe, refractory connective tissue diseases. The main barriers cited were high costs (82%), limited clinical experience (65.5%) and applicability in only a limited number of patients (35.4%). Knowledge of side effects (e.g., cytokine release syndrome, infections, hypogammaglobulinemia) and contraindications (e.g. heart failure, chronic infections) was generally accurate. Yet, the self-appraisal of existing knowledge on TCRT was only seen as medium by the questioned rheumatologists (median of 4.86, on a 0 to 10 scale with 10 is best knowledge). Participating German rheumatologists demonstrated a high willingness to refer patients for TCRTs and appeared to possess good safety knowledge. However, the therapy is currently viewed as a niche option for highly active, refractory cases, with costs and limited data serving as primary barriers to broader implementation.