对22名使用阿尼洛单抗治疗难治性皮肤狼疮患者的回顾性研究

Elliott Herron, Lauren Graham, Andrew Fortugno
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摘要

皮肤红斑狼疮(CLE)是一种异质性疾病,可单独表现为皮肤病,也可与系统性红斑狼疮(SLE)同时出现。尽管CLE通常病情严重,生活质量下降,但目前仍没有FDA批准的治疗CLE的药物。Anifrolumab 是一种全人源化的 IgG1κ 单克隆抗体,由于在系统性红斑狼疮试验中对皮肤有明显改善,它已成为一种备受关注的药物。我们对 2022 年 1 月至 11 月期间开始接受阿尼洛单抗输注治疗的 24 名患者进行了回顾性病历审查。22名患者还被确定为除系统性红斑狼疮外还患有CLE。病历审查截至 2023 年 8 月 21 日。 在这22名患者中,有13名患者(59%)能够减少或停用泼尼松或改善病情抗风湿药(DMARD)。具体来说,22 名患者中有 8 名(36%)完全停用了至少一种 DMARD。值得注意的是,16 名患者(70%)在开始使用泼尼松时使用了 anifrolumab,其中 8 名患者(50%)能够完全停用泼尼松。二十二名患者中有十七人(77%)的皮损有所改善,表现为皮疹消退、自开始治疗以来没有复发、色素沉着、毛发再生或红斑和鳞屑减少。在接受复查的 24 名患者中,有两名没有明确的皮肤狼疮证据,但他们的皮肤疾病可能与系统性红斑狼疮有关,因此没有被纳入数据分析,但在表 2 中有所体现。阿尼洛单抗能减轻疾病负担,减少其他疗法的使用,而且总体上可以耐受,因此对 CLE 患者来说是一种很有前景的疗法。
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 A Retrospective Review of 22 patients on Anifrolumab in Refractory Cutaneous Lupus
Cutaneous lupus erythematosus (CLE) is a heterogeneous disorder that can present alone as cutaneous disease or in conjunction with systemic lupus erythematosus (SLE). Despite CLE often being severe and worsening quality of life, there is still no FDA approved drug for CLE. Anifrolumab, a fully humanized IgG1κ monoclonal antibody, has become a drug of interest because of its significant skin improvement in the SLE trials. We performed a retrospective chart review of a cohort of twenty-four patients initiating anifrolumab infusion therapy from January to November 2022. Twenty-two patients were also identified as having CLE in addition to SLE. Chart review occurred up to August 21, 2023.     Of the twenty-two patients, thirteen (59%) were able to reduce or stop either prednisone or a disease-modifying antirheumatic drug (DMARD). Specifically, eight patients (36%) of the twenty-two completely stopped at least one DMARD. Notably sixteen patients (70%) started anifrolumab on prednisone with eight (50%) being able to discontinue prednisone completely. Seventeen (77%) of the twenty-two had improvement of skin lesions by resolution of rash, no flares since therapy initiation, repigmentation, hair regrowth, or decrease in erythema and scale. Two of the total twenty-four patients reviewed did not have clear evidence of cutaneous lupus although did have cutaneous disease likely related to SLE, therefore were not included in data analysis although are represented in Table 2. The decrease in disease burden, ability to decrease other therapies, and overall tolerability of anifrolumab makes it a promising therapy for those with CLE.  
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