Anifrolumab considerably improves outcomes in refractory discoid lupus erythematosus

A new article published in the Journal of American Medical Association suggests that in a short retrospective research, every patient with discoid lupus erythematosus (DLE) who had not reacted to many common treatments showed considerable improvement when given anifrolumab (Saphnelo).

DLE is a kind of chronic cutaneous lupus that can leave people with permanent scarring and deformity. An interesting result from one of the pivotal trialsopens in a new tab or window supporting anifrolumab's approval for systemic lupus in 2021, according to Shaw and colleagues, was that 49% of patients taking the medication demonstrated at least a 50% reduction in skin manifestations, as opposed to 25% of the placebo group. A monoclonal antibody, anifrolumab targets the type 1 interferon receptor subunit 1 and has a distinct mode of action. As type 1 interferon expression is known to be correlated with the activity of the DLE illness, they proposed that anifrolumab would be a suitable treatment for DLE patients.

The mean scores on the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) activity subscale decreased by 65% among eight patients who received anifrolumab treatment for at least eight weeks. The researchers reported their findings in JAMA Dermatology opens in a new tab or window. All patients saw some drop in CLASI activity levels, ranging from 46% to 79%. In every instance, patients assessed their pain and itchiness as "much better" and no side effects were noted.

A collection of before-and-after images of one "representative" patient, a Black lady in her 40s, were included in this piece. The woman had crusty lesions on her arms, head, and chest, as well as full baldness on her scalp before beginning anifrolumab. After using the medication for two months, the scaling was virtually gone. By month six, the researchers said, her daily prednisone dosage had been reduced from 10 mg to 2 mg. Nonetheless, there were still patches of hyper- and hypo-pigmentation, and there was no sign of hair regrowth. This was anticipated in situations of chronic DLE since certain consequences, such scarring, are irreversible. No patient in the research really had a decrease in their score on the 56-point CLASI damage subscale of more than two points.

These preliminary findings show promise for anifrolumab as a treatment alternative for DLE patients, particularly those with severe or resistant illness. To verify the advantage, they urged bigger prospective trials.

Reference: 

Shaw, K., Sanchez-Melendez, S., Taylor, D., Barker, J., LaChance, A., Shahriari, N., & Vleugels, R. A. (2023). Assessment of Clinical Response to Anifrolumab in Patients With Refractory Discoid Lupus Erythematosus. In JAMA Dermatology. American Medical Association (AMA). https://doi.org/10.1001/jamadermatol.2023.0175