Rapid clearance of cutaneous lesions with anifrolumab in SLE (systemic lupus erythematosus) and DLE (discoid lupus erythematosus)

Abstract

Background

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs, including the skin. Activation of the Type I interferon pathway is a key pathophysiological factor in SLE. Discoid lupus erythematosus (DLE) is a chronic cutaneous form of lupus and treatment is challenging with an increased risk of disfigurement and poor quality of life. Treatment of cutaneous manifestations is challenging and current standard therapies remain inadequate. Anifrolumab is a monoclonal antibody that targets the Type 1 interferon receptor subunit 1. Phase III clinical trials (TULIP-1, TULIP-2 and MEDI-546) have demonstrated its efficacy in reducing SLE activity and improving lupus-associated skin manifestations.

Objectives

The aim of this retrospective study was to provide information on the early effect of anifrolumab in patients with cutaneous manifestations of lupus with and without systemic involvement.

Methods

A retrospective study evaluating the early effect of anifrolumab in six patients with refractory cutaneous manifestations of lupus, including those with DLE with and without associated SLE. The outcome measure was the change in Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) score at 1–2 months. Photographs were performed before and after treatment.

Results

The mean baseline CLASI score was 14.2 ± 10.6 (median: 10.5). At 1–2 months, the CLASI score was 5.7 ± 5.3 (median: 3.0). The clinically remarkable efficacy was visible in most patients after the first injection of anifrolumab.

Conclusions

We observed the rapid efficacy of anifrolumab within the first 2 months in patients with refractory cutaneous manifestations of SLE and CLE. Limitations include the small sample size and lack of a control group. Overall, anifrolumab represents a potential therapeutic option for severe or resistant cutaneous lupus and warrants further investigation. Research is needed to determine its optimal use and efficacy in different cutaneous lupus subtypes.