Biological therapies in the treatment of cutaneous lupus erythematosus

Abstract

Cutaneous lupus erythematosus (CLE) is an autoimmune skin disease occurring in association with or without systemic lupus erythematosus (SLE). Although antimalarials are widely used as the first-line systemic agent, refractory cases may benefit from additional immunomodulators, immunosuppressives, and biologics. An interest in biological therapies for CLE has emerged in recent years due to novel insight into the pathogenesis of CLE. These targets include B cells, T cells, and cytokines that are involved in immune system pathways. Currently belimumab is the only biological therapy approved for SLE and no biologic has been approved for CLE. While there is a paucity of high quality evidence with regard to biologics in CLE management, trials are currently being performed to determine their role.

Advancing understanding, diagnosis, and therapies for cutaneous lupus erythematosus within the broader context of systemic lupus erythematosus

“…Sifalimumab, an anti-IFN-α monoclonal antibody, was assessed in SLE patients with moderate to severe disease in a phase IIb, randomized, double-blind, placebo-controlled study. The percentage of patients with improvements in CLASI was greater for all sifalimumab doses compared with the placebo, although Herpes zoster infections were more frequent with sifalimumab treatment 41, 48 . Despite such promising results, this trial was discontinued to further assess anifrolumab, an anti-IFN-α receptor monoclonal antibody that binds the type I IFN-α/β/ω receptor (IFNAR), preventing signaling by all type I IFNs 42 .…”

“…Belimumab is a monoclonal antibody directed against B-lymphocyte stimulator (BLyS), an immunomodulatory cytokine that stimulates B-cell differentiation and survival 48 . A multicenter, randomized, controlled, phase III trial assessed the safety and efficacy of this medication, comparing belimumab plus standard therapy with placebo plus standard therapy in patients with SLE 49 .…”

Candidate drug replacements for quinacrine in cutaneous lupus erythematosus

“…One open-label study of five patients with CLE showed a good clinical response based on CLASI scores; however, larger prospective studies are needed to truly determine its role in CLE. 81 82 …”

Lupus panniculitis refractory to multiple therapies treated successfully with rituximab: A case report and literature review

“…Rituximab seems to be effective in treating refractory acute cutaneous lupus erythematous and bullous lupus erythematosus, but it is less effective in the management of chronic cutaneous lupus erythematosus. 5 Only a few cases of refractory lupus panniculitis treated successfully with rituximab have been described in the literature (Table S1), including this case. [2][3][4] All patients were women between 22 and 57-years of age (mean 43 years).…”