Anifrolumab for systemic lupus erythematosus with multi-refractory skin disease: A case series of 18 patients.

Autor: Flouda S; Rheumatology and Clinical Immunology Unit, Attikon University Hospital, Athens, Greece., Emmanouilidou E; Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece., Karamanakos A; Department of Rheumatology, Evangelismos General Hospital, Athens, Greece., Koumaki D; Department of Dermatology, University Hospital of Heraklion, Heraklion, Greece., Katsifis-Nezis D; Rheumatology and Clinical Immunology Unit, Attikon University Hospital, Athens, Greece., Repa A; Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece., Bertsias G; Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece., Boumpas D; Rheumatology and Clinical Immunology Unit, Attikon University Hospital, Athens, Greece., Fanouriakis A; Rheumatology and Clinical Immunology Unit, Attikon University Hospital, Athens, Greece.
Jazyk: angličtina
Zdroj: Lupus [Lupus] 2024 Oct; Vol. 33 (11), pp. 1248-1253. Date of Electronic Publication: 2024 Aug 04.
DOI: 10.1177/09612033241273023
Abstrakt: Objective: Skin involvement is common in systemic lupus erythematosus (SLE), but may be resistant to conventional treatment. We sought to evaluate the efficacy of anifrolumab (ANI) in refractory cutaneous manifestations of SLE.
Methods: Case series of patients with refractory cutaneous SLE from three Rheumatology Departments in Greece. Outcome measures were improvement in Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), physician global assessment (PGA) and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Clinically relevant improvement in skin was defined as decrease ≥50% (CLASI50) from baseline values.
Results: Eighteen patients received ANI; all had active skin involvement at baseline. Mean (SD) SLEDAI and PGA at ANI initiation were 7.4 (2.7) and 1.4 (0.5), respectively, with a mean prednisone dose 4.9 (4.5) mg/day. Mean CLASI (Activity/Damage) at baseline was 13.9 (9.7)/2.9 (4.6). Patients were refractory to a mean 6.3 (1.5) immunomodulatory agents (including hydroxychloroquine and glucocorticoids) before the initiation of ANI. After a mean 8.5 (4.6) months, 89% ( n = 16/18) of patients demonstrated significant improvement in general lupus and cutaneous disease activity, and glucocorticoid tapering. Mean SLEDAI and mean CLASI at last visit were 3.4 (1.9) and 2.1 (2.4)/1.4 (2.2), respectively, and mean daily prednisone dose decreased to 2.4 (2.2). Of note, in this group of highly refractory patients CLASI50 was achieved in 16/18 (89%) patients. One patient discontinued ANI after 4 infusions due to a varicella-zoster virus infection and one patient, who initially responded to treatment with ANI, experienced a skin flare due to temporary discontinuation due to Covid 19 infection. DORIS remission and LLDAS were attained in two (11.1%) and eleven (61.1%) patients, respectively.
Conclusion: Anifrolumab is highly effective in various skin manifestations of SLE, even after prior failure to multiple treatments.
Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze: MEDLINE
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