Evaluating the Effectiveness and Tolerability of Chimeric Antigen Receptor (CAR) T Cells Therapy in Patient with Systemic Lupus Erythematosus: A Systematic Review

Background

Systemic Lupus Erythematosus (SLE) is a complex auto-immune disorder characterized by immune dysregulation leading to formation of autoantibodies and multiple organ dysfunction. Monoclonal antibodies targeting CD19 and CD20 on the B lymphocytes have demonstrated benefit, however, relapse is common. Chimeric antigen receptor (CAR) T cells targeting CD19 on B lymphocytes have shown to eliminate B lymphocytes both from the circulation and lymphoid organs leading to durable responses and have been approved for treatment for different forms of cancer including acute lymphoblastic leukemia, multiple myeloma and non-Hodgkin lymphoma. More recently, clinical trials are evaluating the effectiveness of CAR T-cell therapy in patients with SLE refractory to current lupus therapeutics.

Method

We did electronic search of the literature using Central Line (PubMed), EMBASE, and google scholar databases until July 2024. We searched for case-series, observational studies and randomized clinical trials to investigate the effectiveness of CAR-T therapy in SLE. PRISMA guideline was followed to conduct the study. Studies were filtered based on title and abstract, followed by the full text. Data extraction was done in Microsoft Excel.

Results

We evaluated a total of 3 studies which included a total number of 25 patients who received CART- Therapy for refractory SLE. All the included studies were case series. SLEDAI-2K score ranged from 1.5 to 0 and DORIS remission was achieved in all patients. C3 level was normalized, and dsDNA level were below cutoff for all the patients reflecting good treatment response. Most of the patients tolerated the treatment well and only mild cytokine release syndrome was reported. Immune-Effector Cell Associated Neurotoxicity Syndrome (IECANS) and infections rate were negligible.

Conclusion

Anti-CD19 CAR-T therapy has shown promising result in a small population to prevent relapses in patients with SLE by eliminating CD19 positive B lymphocytes and is relatively well tolerated with mild adverse effects. Future large studies including controlled clinical trials are expected to further evaluate safety and tolerability of CAR-T therapy in autoimmune conditions including SLE.

No relevant conflicts of interest to declare.

Use of CAR T-cells therapy in patients with systemic lupus erythematosus.