Complete remission of SLE after treatment with cancer drug

PD Dr. med. Tobias Alexander from the Department of Rheumatology at Charité – Universitätsmedizin Berlin and liaison group leader at the DRFZ and Prof. Jan Krönke from the Department of Hematology, Oncology and Tumor Immunology at Charité have treated a patient with systemic lupus erythematosus (SLE), for whom all conventional treatment strategies had failed, with the cancer drug Teclistamab as part of an “off-label” therapy. The patient went into clinical remission and is still symptom-free six months after starting treatment. The results were recently published in the journal the New England Journal of Medicine.

Teclistamab is a bispecific antibody that binds to a molecule, BCMA, on the surface of plasma cells and their precursor cells as well as to a signaling molecule, CD3, on killer T cells. The binding of Teclistamab to BCMA and CD3 forms a link between the two cells. This induces T-cell activation and the subsequent elimination of the plasma cells. In SLE, plasma cells produce autoantibodies that attack the tissue and thus cause the symptoms of the disease. The effective elimination of plasma cells and their precursors could lead to long-term therapeutic success.

After five injections over a period of five weeks, the treatment proved to be remarkably  effective: the patient’s symptoms decreased, her kidney and blood values normalised and autoantibodies were no longer detectable. The patient is currently in complete remission, but it remains uncertain how long the effect will last.

The treatment carries risks, including severe cytokine release syndrome and other side effects that required intensive treatment. These side effects are to be expected with Teclistamab, as seen with the treatment of multiple myeloma.

The treatment team continues to monitor the patient closely. If the effect proves to be long-term, Teclistamab could represent a significant alternative to more complex therapies such as CAR-T cell therapies, as it would be easier and faster to use.