Efalizumab in the Treatment of Discoid Lupus Erythematosus

Abstract

Background: Discoid lupus erythematosus is a chronic inflammatory condition in which the pathogenesis and the role of cell-mediated immunity remains unclear. Currently, the most effective treatments for severe disease are thalidomide, methotrexate, and cyclosporin, although the evidence for this is limited. Efalizumab is a monoclonal antibody directed against CD11a, the ␣-subunit of the leukocyte-functioning antigen 1, with a current license for use in psoriasis. Because discoid lupus erythematosus is known to be predominantly T-cell mediated, our aim was to use efalizumab as a T-cell modulator in patients with recalcitrant disease. Observations: Thirteen patients received efalizumab, with treatment responses varying from good to excellent in 12 of 13 patients. There was a significant reduction in the cutaneous lupus activity and severity score (CLASS) score after therapy with efalizumab (P=.002). Conclusions: We have presented efalizumab as a novel alternative treatment for patients with difficult discoid lupus erythematosus. The response to treatment in 12 patients was very encouraging, with the mean time to response being 5.5 weeks. However, patient numbers were small, and many remain in the early stages of therapy. A prospective randomized study with a long-term follow-up is required, especially in light of recent findings to evaluate both the effectiveness and safety profile of this monoclonal antibody.

Early Diagnosis and Treatment of Discoid Lupus Erythematosus

“…After 20 applications all of the lesions regressed significantly. Usmani and Goodfield 30 reported good to excellent responses in 12 out of 13 patients with DLE who were treated with efalizumab, a monoclonal antibody directed against CD 11a (discoid lupus is known to be predominantly t-cell mediated). Finally, Koch et al 31 suggest cryotherapy as a treatment option in cases of DLE lesions that are resistant to local or systemic recommended therapy.…”

Efficacy and safety of pulsed dye laser treatment for cutaneous discoid lupus erythematosus

“…[1][2][3] Current treatment options include topical and systemic glucocorticosteroids, 4-6 sunscreens, 7 antimalarial agents, 8,9 retinoids, 10,11 dapsone, 12 methotrexate, 13 thalidomide, 14 immunoglobulins, 15 azathioprine, 16 and cyclophosphamide. 17 Occasionally, beneficial effects of topical immunomodulators, 18,19 biologicals, 20,21 cyclosporin, 22 immunoglobulins, 23 mycophenolate mofetil, 24 rituximab, 25 and anti-tumor necrosis factor alfa agents 26 have been reported. When a lack of efficacy or adverse events is experienced, physical and surgical therapies including cryotherapy, dermabrasion, and laser treatment have been tried.…”

Cutaneous manifestations of systemic lupus erythematosus

“…Treatment with single-agent or combination with aminoquinoline antimalarial will suffice for 75% of SCLE patients. In particular clinical cases, the remaining 25%, have been treated with other pharmacologic forms, as antiinflammatory or systemic immunosuppressive-immunomodulatory therapies, which includes auranofin, dapsone, thalidomide, retinoids, interferon, and immunosuppressive agents [53][54][55][56]. …”