CAR-T cell therapy appears to be effective for severe systemic lupus according to a small recent study.
By Dr. Robert Katz, LSI Board Chair and LSI Medical Advisory Board Chair
(CAR T-cell therapy, typically used in cancer treatment, is a form of immunotherapy.
In CAR T-cell therapy, blood is taken from a person, T cells, a type of immune system cell, are collected. T-cells travel around the body to target and destroy cells that are defective.
CAR T-cell therapy cells are taken from an individual’s blood, modified in a lab to target a defective cell and then put back into a person through an infusion.)
The researchers looked at CAR-T treatment, which is chimeric antigen receptor T cells. Patients responded remarkably well at three months. At present, CAR-T therapy is used for lymphoma and myeloma, two malignancies. The side effects were few in this small study. Patients were first treated with cyclophosphamide and another medicine, fludarabine, causing lymphocytes, a type of white blood cell, to be depleted. The CAR-T cells then expanded and depleted the B lymphocytes, which produce antibodies including autoimmune antibodies in lupus.
At three months all five patients had reached lupus drug free remission, which was maintained during a follow-up period of eight months.
This is a small study and an early study, but does point to a promising therapy for severe active lupus not responding to other therapies. The tools to eradicate B lymphocyte cells producing antibodies can be used in lupus if the study is expanded and approved for systemic lupus. In the meantime, it is a therapy that requires more investigation, but is potentially promising for severe lupus, not ordinary, milder lupus.
Robert S. Katz, M.D.
Article published Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus, Nature Medicine, September 15, 2022. See abstract here.