{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:37:41Z","timestamp":1793230661769,"version":"4.5.0"},"reference-count":38,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"unspecified","delay-in-days":62,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,1,13]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Current therapeutic paradigms for treatment-refractory rheumatic diseases rely on chronic immunosuppression with variable efficacy and potential for cumulative toxicity. We systematically synthesised evidence on the clinical efficacy, safety and durability of chimeric antigen receptor T-cell (CAR-T) therapy in autoimmune rheumatic diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO: CRD42025641602). Five databases were searched from inception to February 2025 for primary studies investigating CAR-T therapy in autoimmune rheumatic diseases. Two reviewers independently assessed studies using the Joanna Briggs Institute tools and the Risk of Bias in Non-Randomised Studies of Interventions tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>12 studies encompassed 44 patients with severe treatment-refractory disease across six rheumatic conditions. Patients had extensive prior exposure (median 5 therapies), including conventional and biological agents. Cluster of Differentiation antigen 19 (CD19)-targeted constructs predominated (83% of studies), with emerging dual-target approaches (17%). Universal clinical responses were achieved (100% of studies; individual response rates 92%\u2013100%), with complete responses occurring within 2\u201316 weeks. Sustained drug-free remissions extended 6\u201346 months, accompanied by profound autoantibody reductions (80%\u201399% across disease-specific markers). Safety profiles diverged markedly from oncological experience: cytokine release syndrome (CRS) remained exclusively confined to grades 1\u20132, while immune effector cell-associated neurotoxicity occurred in 25% of studies, with predominantly grade 1 severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CAR-T therapy demonstrates substantial efficacy in treatment-refractory rheumatic diseases, achieving sustained remissions through comprehensive B-cell elimination. Importantly, safety profiles were favourable, with CRS limited to grades 1\u20132 severity, no grade \u22653 events and rare immune effector cell-associated neurotoxicity, representing markedly superior tolerability compared with oncological applications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42025641602.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006417","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T14:05:19Z","timestamp":1772633119000},"page":"e006417","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["CAR-T cell therapy for treatment-refractory rheumatic autoimmune diseases: a systematic review of clinical outcomes and safety profiles"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7320-4552","authenticated-orcid":false,"given":"Anindita","family":"Santosa","sequence":"first","affiliation":[{"name":"Aaria Rheumatology, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tze Chin","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"2026030406050992000_12.1.e006417.1","doi-asserted-by":"crossref","first-page":"e434","DOI":"10.1016\/S2665-9913(24)00377-1","article-title":"CAR T-cell therapy in autoimmune diseases: where are we and where are we going?","volume":"7","author":"Scherlinger","year":"2025","journal-title":"Lancet Rheumatol"},{"key":"2026030406050992000_12.1.e006417.2","doi-asserted-by":"crossref","first-page":"e355","DOI":"10.1016\/S2665-9913(24)00338-2","article-title":"Evolution and trajectory of B-cell targeted therapies in rheumatic diseases","volume":"7","author":"Carter","year":"2025","journal-title":"Lancet Rheumatol"},{"key":"2026030406050992000_12.1.e006417.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61499-3"},{"key":"2026030406050992000_12.1.e006417.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-025-03490-2","article-title":"Impact of disease duration on systemic clinical profile in Sjogren\u2019s syndrome","volume":"27","author":"Wu","year":"2025","journal-title":"Arthritis Res Ther"},{"key":"2026030406050992000_12.1.e006417.5","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/j.tips.2024.07.005","article-title":"Frontiers in CAR-T cell therapy for autoimmune diseases","volume":"45","author":"Li","year":"2024","journal-title":"Trends Pharmacol Sci"},{"key":"2026030406050992000_12.1.e006417.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.jtauto.2024.100264","article-title":"Cellular therapies in rheumatic and musculoskeletal diseases","volume":"10","author":"Franco-Fuquen","year":"2025","journal-title":"J Transl Autoimmun"},{"key":"2026030406050992000_12.1.e006417.7","doi-asserted-by":"crossref","unstructured":"Smith J . 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