Long-term efficacy and safety outcomes of lenalidomide for cutaneous lupus erythematosus: A multicenter retrospective observational study of 40 patients

Aitmehdi, Raphael; Arnaud, Laurent; Francès, C.; Senet, Patricia; Monfort, J.‐B.; Risi-Pugliese, T. De; Barbaud, A.; Cohen‐Aubart, Fleur; Haroche, Julien; Pha, M.; Hié, M.; Guern, Véronique Le; Costédoat-Chalumeau, Nathalie; Mékinian, A.; Fain, Olivier; Mathian, Alexis; Amoura, Zahir; Chasset, François

doi:10.1016/j.jaad.2020.11.014

Cited by 19 publications

(13 citation statements)

References 7 publications

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“…42,50,[82][83][84] In several non-comparative trials and observational studies, lenalidomide proved efficacious in treating refractory CLE, without inducing or worsening peripheral neuropathy. 45,50,84,85 77-100% of patients in different studies achieved clinical response, 45,50,84,85 and at least 43-86% achieved complete response as determined by a CLASI activity score of 0. 45,50,85 Lenalidomide was found to be safe and effective in the treatment of refractory cutaneous manifestations of SLE in pediatric patients; in a retrospective study of 10 adolescents, 100% of patients achieved complete or near complete resolution at 6 months of treatment, including hair regrowth in patients with extensive alopecia.…”

Section: Dapsonementioning

confidence: 99%

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Recent Insight on the Management of Lupus Erythematosus Alopecia

Desai¹,

Miteva²

2021

CCID

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Lupus erythematosus (LE) is a chronic autoimmune condition with a wide spectrum of clinical presentations. Alopecias, both non-scarring and scarring, frequently occur in the context of LE and can assume several different patterns. Furthermore, alopecia occurring with LE may be considered LE-specific if LE-specific features are present on histology; otherwise, alopecia is considered non-LE-specific. Non-scarring alopecia is highly specific to systemic LE (SLE), and therefore has been regarded as a criterion for the diagnosis of SLE. Variants of cutaneous LE (CLE), including acute, subacute, and chronic forms, are also capable of causing hair loss, and chronic CLE is an important cause of primary cicatricial alopecia. Other types of hair loss not specific to LE, including telogen effluvium, alopecia areata, and anagen effluvium, may also occur in a patient with lupus. Lupus alopecia may be difficult to treat, particularly in cases that have progressed to scarring. The article summarizes the types of lupus alopecia and recent insight regarding their management. Data regarding the management of lupus alopecia are sparse and limited to case reports, and therefore, many studies including in this review report the efficacy of treatments on CLE as a broader entity. In general, for patients with non-scarring alopecia in SLE, management is aimed at controlling SLE activity with subsequent hair regrowth. Topical medications can be used to expedite recovery. Prompt treatment is crucial in the case of chronic CLE due to potential for scarring and irreversible damage. First-line therapies for CLE include topical corticosteroids and oral antimalarials, with or without oral corticosteroids as bridging therapy. Second and third-line systemic treatments for CLE include methotrexate, retinoids, dapsone, mycophenolate mofetil, and mycophenolate acid. Additional topical and systemic medications as well as physical modalities used for the treatment of lupus alopecia and CLE are discussed herein.

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Section: Dapsonementioning

confidence: 99%

“…86 Similar to thalidomide, however, lenalidomide was associated occasionally with arterial thromboses 85 and frequent relapse upon dose reduction or discontinuation. 50,85 Fumaric Acid Esters (FAEs)…”

Section: Dapsonementioning

confidence: 99%

Recent Insight on the Management of Lupus Erythematosus Alopecia

Desai¹,

Miteva²

2021

CCID

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“…The increased incidence of ON in SLE patients as compared to the general population, patients with other autoimmune diseases, or diseases requiring high doses of corticosteroids (CS) suggest that the disease itself and/or the underlying genetic background of the patients might dictate the susceptibility in its occurrence. [1][2][3][4][5] Several modifiable risk factors have been associated with an increased risk of ON, such as alcohol intake, cigarette smoking, high triglyceride levels, and heavy physical work. The use of CS has been recognized as a major risk factor for the development of ON.…”

Section: Learning Objectivesmentioning

confidence: 99%

“…3 In case of failure of thalidomide, lenalidomide 5 mg/day a 4-amino-glutamyl analogue of thalidomide has shown promising results with partial response of 88% in a retrospective study of 40 patients. 4 Importantly, no cases of new or worsening peripheral thalidomide-induced neuropathy was reported with lenalidomide. 4 A case of progression to SLE with renal involvement was reported in a patient with isolated CLE after starting lenalidomide.…”

mentioning

confidence: 99%

“…4 Importantly, no cases of new or worsening peripheral thalidomide-induced neuropathy was reported with lenalidomide. 4 A case of progression to SLE with renal involvement was reported in a patient with isolated CLE after starting lenalidomide. 5 Recent data did not confirm this finding but suggested that lenalidomide has little or no effect on global SLE activity.…”

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confidence: 99%

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30 Refractory cutaneous lupus: use of thalidomide or lenalidomide for refractory lupus skin disease

Chasset

2021

Abstracts

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Clinical Images: Chronic, refractory childhood‐onset cutaneous lupus erythematosus of the face responsive to lenalidomide

Sherman

Kirkorian

Cardis

et al. 2022

Arthritis & Rheumatology

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Clinical Images: Chronic, refractory childhood-onset cutaneous lupus erythematosus of the face responsive to lenalidomideThe patient, an 11-year-old girl with anti-Ro/SSA and hypergammaglobulinemia, presented in 2013 with prominent facial eruption consisting of red to purple nodules concentrated on the forehead, around the eyebrows, and on the cheeks that resulted in significant hyperpigmentation, scarring, and atrophy. This pattern was consistent with a diagnosis of cutaneous lupus (A); the patient had no signs of systemic lupus erythematosus. The rash was refractory to hydroxychloroquine (HCQ), topical calcineurin inhibitor, topical steroids, intralesional steroids, oral steroids, dapsone, azathioprine, and mycophenolate. The patient's course was complicated by intermittent follow-up and frequent periods of not receiving medications. Systemic therapies were discontinued by the family prior to the COVID-19 pandemic. Biopsy was repeated in September 2020 because of ongoing disease activity and diagnostic uncertainty. Histologic examination revealed a superficial and deep perivascular and periadnexal lymphohistiocytic infiltrate associated with mild overlying interface changes, telangiectasias, and increased dermal mucin consistent with chronic cutaneous lupus (B). Lenalidomide (LND) has been found to be effective and generally well tolerated in refractory cases of cutaneous lupus in adults and adolescents (1-3). The typical starting dosage is 5 mg per day for both age groups. In February 2021, LND 2.5 mg was started, with a plan to titrate up based on clinical response, in combination with HCQ. At most recent follow-up in May 2021, the patient had significant improvement in cutaneous lesions and has remained on the initial dose (C). The patient has tolerated LND thus far without apparent adverse effects, such as cytopenias or neuropathy. Due to risk of teratogenicity, monthly urine pregnancy tests have been required since the patient reached menarche.

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Long-term efficacy and safety outcomes of lenalidomide for cutaneous lupus erythematosus: A multicenter retrospective observational study of 40 patients

Cited by 19 publications

References 7 publications

Recent Insight on the Management of Lupus Erythematosus Alopecia

Recent Insight on the Management of Lupus Erythematosus Alopecia

30 Refractory cutaneous lupus: use of thalidomide or lenalidomide for refractory lupus skin disease

Clinical Images: Chronic, refractory childhood‐onset cutaneous lupus erythematosus of the face responsive to lenalidomide

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