The LUNAR trial is an RCT that tested whether rituximab added to steroids and mycophenolate mofetil provided additional benefit in lupus nephritis. It did not. This is a curious result for an antibody mediated disease like lupus nephritis. People theorize that rituximab's B-cell ablating ability may depend on an intact complement system and that since complement is depleted in lupus nephritis, rituximab may have been unable to fully deplete B-cells.

Last year Nature Medicine published a study about using CAR-T as a CD19 depleting therapy in patients with lupus. It seemed to work–inducing drug-free remission in all 5 patients, for an average of 10 months.

Well Fabian Müller is back with an update at this year's American Society of Hematology. Now they have 15 patients and have maintained the sharp safety and efficacy record. 

"So far, the 15 patients in the study have been followed for a median of 15 months after their CAR-T infusions. All are doing well and have stopped taking immunosuppressive drugs. Two-thirds experienced a mild form of cytokine release syndrome, an immune side effect of CAR-T therapy, but there were no serious treatment-related adverse events."

Here is NephJC's coverage of the Nature Medicine article from 2022.

But keep your foot near the brakes, because there is a new cancer signal in CAR-T that could dampen enthusiasm for adapting the technology in less immediately lethal diseases (SLE, immune mediated myositis, scleropderma are all being targeted with CAR-T therapies)

Interesting podcast exploring the culture around the "on-call pager." I gave up my beeper over a decade ago but like fax machine, obsolete technologiers get rooted in mediine and are hard to displace.