OR WAIT null SECS
The Future of CAR-T in Lupus Nephritis Treatment, With Brad Rovin, MD
CAR-T therapy in lupus may shift earlier in care, but challenges in access, logistics, and patient selection remain as the field moves toward precision treatment.
The emergence of CAR-T cell therapy in lupus nephritis has generated significant excitement, but questions remain around how and when this intensive approach should be used. While early studies have focused on patients with refractory disease, the broader clinical vision may extend much earlier in the disease course, particularly as safety and feasibility continue to improve.
In an interview with HCPLive at at the World Congress of Nephrology (WCN) Conference in Yokohama, Japan, Brad Rovin, MD, said the current emphasis on refractory populations reflects regulatory caution, ensuring that higher-risk therapies are first tested in patients with limited alternatives. However, he suggests this approach may not fully capture the therapy’s potential.
Check out part 1 of the interview with Rovin here.
Patients with longstanding, treatment-resistant disease often have accumulated, irreversible damage, which may limit the likelihood of achieving full recovery. In contrast, he envisions a future where CAR-T therapy could be used earlier, potentially at the time of diagnosis, to alter the disease trajectory before significant organ damage occurs.
He emphasizes that this shift could be particularly meaningful for the predominantly young patient population affected by lupus nephritis, as conventional treatment regimens often involve prolonged immunosuppression, multiple medications, and significant side effects, all of which can disrupt education, careers, and family planning. If CAR-T therapy can be delivered safely and efficiently, it may offer the possibility of durable remission with reduced long-term treatment burden.
Despite this promise, Rovin notes that logistical barriers remain. Current autologous CAR-T approaches require harvesting and engineering a patient’s own cells, a process that can take weeks and may necessitate holding background immunosuppression. This delay, along with the need for hospitalization, complicates real-world implementation. Looking ahead, he highlights the potential of allogeneic, “off-the-shelf” CAR-T products designed to evade immune rejection, which could streamline delivery and enable outpatient administration.
He also points to emerging alternatives, such as bispecific antibodies that engage T cells without requiring cell harvesting. While these agents may offer greater convenience, they still carry risks such as cytokine release syndrome and require careful evaluation.
Ultimately, he underscores that the future of CAR-T therapy will depend on advances in precision medicine. Identifying which patients are most likely to benefit and aligning treatment strategies with patient preferences will be critical. As the evidence base rapidly expands, he stresses the importance of shared decision-making and continued clinical investigation to define the optimal role of these therapies in lupus care.
Editors’ note: Relevant disclosures for Rovin include Biogen, GSK, Genentech/Roche, BMS, Travere, Alexion, Novartis, AstraZeneca, Otsuka, Calliditis, and others.
References
Yang C, Sun C, Tan B, et al. Allogeneic anti-CD19 CAR-T cells induce remission in refractory systemic lupus erythematosus. Cell Res 35, 607–609 (2025). https://doi.org/10.1038/s41422-025-01128-1
Hsieh EWY, Chung JB, Amin A, et al. Key considerations for advancing chimeric antigen receptor (CAR) T-cell therapy for systemic lupus erythematosus (SLE): a multi-partner/disciplinary working group perspective. RMD Open. 2025;11:e005866. https://doi.org/10.1136/rmdopen-2025-005866
Related Content:
