CAR-T Cell Therapy in Rheumatic Diseases

CAR-T cell (Chimeric Antigen Receptor-T cell) therapy has revolutionized the treatment of various hematologic malignances. CD19 targeted CAR-T cell therapy is coming in a big way in rheumatic diseases. Recent case reports and case series have shown encouraging results in diseases like systemic lupus erythematosus (SLE), systemic sclerosis and antisynthetase syndrome which have been refractory to multiple existing therapies. The dramatic response encompasses objective improvement across multiple clinical domains as well as seroconversion. Side effects of concern with CAR-T cell therapy are related to release of pro-inflammatory cytokines and include cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). The reported side effects of this therapy for autoimmune diseases were of low grade and were managed without any fatality. Several modifications in CAR-T cell therapy have been proposed to maximize the safety and improving the efficacy. This therapy has got the potential to be a major breakthrough in management of rheumatic diseases, especially wherein existing therapies have been refractory.