Monoclonal Antibodies for the Management of Cutaneous Lupus Erythematosus: An Update on the Current Treatment Landscape.

Abstract

Cutaneous lupus erythematosus is a complex autoimmune disease often characterized by a multitude of skin findings. Cutaneous lupus erythematosus (CLE) is generally classified into three main categories: acute cutaneous lupus (ACLE), subacute cutaneous lupus (SCLE), and chronic cutaneous lupus (CCLE). The current therapeutic guidelines for CLE include counseling patients on general measures and medication regimens. Treatment options include optimized photoprotection, avoidance of environmental triggers, corticosteroids, topical and systemic immunomodulators, and antimalarials. To date, no biologic medications (i.e., monoclonal antibodies [mAbs]) are approved for CLE. The first monoclonal antibody, belimumab, a B-lymphocyte stimulator (BLyS)-specific inhibitor, for the treatment of both systemic lupus erythematosus (SLE) and active lupus nephritis, was approved in 2011 and 2020, respectively. Anifrolumab, a type I interferon (IFN) receptor antagonist, was approved in 2021 for SLE. Other mAbs with different targets, including a novel biologic that inhibits blood dendritic cell antigen 2 (BDCA2), are currently under investigation for CLE. This review will describe the general treatment landscape for CLE. Select studies related to these various mAbs, as well as their safety profiles and efficacies demonstrated in clinical trials, will be discussed. Biologic medications can potentially augment the number of treatment options for patients living with CLE.