CAR T-cell therapy, new drugs ushering in ‘lupus renaissance’
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SCOTTSDALE, Ariz. — Several new drugs and promising therapies, including chimeric antigen receptor T-cell therapy, have ushered in a “lupus renaissance,” said a speaker at the Basic and Clinical Immunology for the Busy Clinician symposium.
According to Emily Littlejohn, DO, MPH, of the Cleveland Clinic, other potential therapies for systemic lupus erythematosus that have emerged since 2020 include monoclonal antibodies and interferons.
“2020 is what many of us consider the lupus renaissance,” Littlejohn told attendees during the hybrid meeting. “This is a time where finally we had many drugs entering the armamentarium very quickly.”
Since the rapid-fire FDA approvals of belimumab (Benlysta, GSK), voclosporin (Lupkynis, Aurinia) and anifrolumab (Saphnelo, AstraZeneca), there have been several promising emerging therapies for SLE, Littlejohn said, with potentially the most exciting being CAR T-cell therapy.
“This is used in the oncology world — we have seen it in [B-cell acute lymphoblastic leukemia], [B-cell non-Hodgkin’s lymphoma] and mantel cell lymphoma,” Littlejohn said. “The question is: What about in our diseases?”
Discussing a German study that enrolled five patients with multi-organ involvement, Littlejohn stated that all included patients were able to reach a state where nephritis ceased. The results provide hope, but the therapy is not without risks, Littlejohn added.
“There is a huge risk of cytokine release syndrome — ICANS in particular — which is very scary,” she said.
“I think there is a lot of promise in this space, just considering these five patients [treated with CAR-T cell therapy] and how well they did,” she added.
Options other than CAR T-cell therapy are also in the pipeline. These include litifilimab (BIIB059, Biogen), interferon--kinoid, obinutuzumab (Gazyva, Genentech) and iberdomide (Bristol Myers Squibb).
Interferon--kinoid failed to meet endpoints in important trials, and its future is “uncertain,” Littlejohn said.
“Litifilimab was initially studied in cutaneous lupus patients, a total of 132,” Littlejohn said. “What they found was that it met primary endpoints with a decrease in skin CLASI score at week 16.”
Additionally, the drug was successful in reducing the number of joints in active disease, according to Littlejohn said.
Finally, obinutuzumab has met its primary endpoint in patients with lupus nephritis, Littlejohn said.
Editor's note: This story was updated on March 1, 2023, to more accurately reflect the nature of the future of iberdomide and interferon--kinoid. The editors regret the error.
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Littlejohn E. Evolving treatments in SLE. Presented at Basic and Clinical Immunology for the Busy Clinician, Feb. 25-26, 2023; Scottsdale, Arizona (hybrid meeting).
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