Is CAR-T cooling down in SARDs? Save

This year at the ACR 2026 convergence meeting there are more than 60 abstracts on CAR-T.  The report of three patients dying from HLH (hemophagocytic lymphohistiocytosis syndrome) put the brakes on two programs of CAR-T studies in systemic autoimmune diseases (SARDs) until a thorough review is conducted.

However, there are some new updates at this year’s meeting.

Tsao et al presented abstract #2773 consensus recommendations for CAR-T cell therapy in the SARDs from the Taiwan College of Rheumatology. They are thorough and outline a sensible approach. 

This treatment should be reserved for severe, treatment refractory patients especially patients with organ- or life-threatening disease. The delivery should be in experienced centers with multidisciplinary teams. SLE patients with high antibody burden failing B-cell targeted therapies may be considered for dual-target treatment (both B cells and plasma cells) within a clinical trial. I am a bit surprised that this statement had high agreement (9/10) and wonder if B cell CAR-T could be sufficient. Another statement with high agreement (8/10) is that CAR-T could be used for refractory D2T rheumatoid arthritis, especially seropositive. I think I would not support this statement but say that properly designed RCTs in RA after failure of multiple advanced therapies and seropositive RA with damage and high disease activity should only be exposed to CAR-T when standard of care is exhausted and in a RCT of some other care pathway vs. CAR-T as in my opinion, the data do not support this statement especially with current uncertainty of benefit, risk, durability of response and cost of this Rx approach in RA. 

Other statements were made all with low grade evidence for subtypes of myositis, systemic sclerosis and even Sjogren’s disease.

What I do applaud the group for is reminding us about vaccinations for patients with SARDs before and after CAR-T therapy.

Of course, this is my opinion: I would recommend that it is best to use T2T and intervene with approved medications in rheumatic diseases early so as to offset the need for experimental interventions later, or basically to use common sense and follow ACR, EULAR and country specific guidelines/recommendations.