#4-88E. Reversing the Irreversible: Teclistamab in Refractory Systemic Sclerosis (ARD, 2026)

Can established fibrosis in severe, treatment-resistant systemic sclerosis (SSc) actually be reversed? This multicenter case series evaluated the off-label use of the BCMAxCD3 bispecific antibody teclistamab in ten patients with refractory SSc. The treatment induced a profound and rapid depletion of B cells and plasma cells within deep tissues, including bone marrow and skin, leading to remarkable clinical improvements in skin fibrosis and interstitial lung disease, alongside significant declines in autoantibody titers. The most groundbreaking discovery of this study is the remarkable efficacy of BCMA-directed therapies to potentially reverse established organ damage, offering a revolutionary therapeutic avenue for patients resistant to conventional treatments. However, a critical appraisal reveals crucial limitations: the small, retrospective nature of the cohort and, critically, the occurrence of fatal events in patients with pre-existing advanced cardiac involvement. For physicians, this study is highly relevant as it heralds a paradigm shift from transient immunosuppression to deep immune reprogramming. It challenges the dogma that SSc fibrosis is irreversible while emphasizing the vital need for stringent patient selection and careful benefit-risk evaluations in clinical practice.

Citation: Siegert E, Alexander T, et al. Teclistamab induces rapid clinical response and deep tissue depletion in refractory systemic sclerosis—a case series. Annals of the Rheumatic Diseases. 2026. DOI: https://doi.org/10.1016/j.ard.2026.05.023

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