Subacute cutaneous lupus erythematosus and dermatomyositis associated with anti‐programmed cell death 1 therapy

Abstract

Summary Programmed cell death 1 (PD‐1) blockade has rapidly emerged as an effective therapy for a wide variety of metastatic malignancies. It has been associated with multiple immune‐related adverse effects, including cutaneous eruptions. We describe two patients with clinical and histological findings that were consistent with subacute cutaneous lupus erythematosus (SCLE) after receiving PD‐1 inhibitor therapy for metastatic lung cancer. We successfully treated our first patient with systemic and topical steroids, photoprotection and hydroxychloroquine. However, he subsequently developed dermatomyositis after continuing PD‐1 inhibitor therapy. Our second patient presented with a protracted course of a cutaneous eruption in spite of discontinuation of anti‐PD‐1 therapy and treatment with systemic corticosteroids and infliximab. This patient's SCLE resolved after the addition of topical steroids and photoprotection and discontinuation of anti‐tumour necrosis factor therapy. She and her oncology team decided to pursue non‐PD‐1 inhibitor treatment for lung cancer owing to a lack of tumour response. We add SCLE and dermatomyositis to the growing list of autoimmune complications of PD‐1 blockade. Our cases raise a number of questions, particularly in relation to the viability of continuing anti‐PD‐1 therapy after developing SCLE and the role of immunosuppressive therapy in patients with PD‐1 inhibitor‐associated connective tissue disease. What's already known about this topic? Programmed cell death 1 (PD‐1) blockade, which is rapidly emerging as a therapy for a wide variety of metastatic malignancies, has been associated with multiple immune‐related adverse effects. These include systemic autoimmune diseases such as colitis and thyroiditis in addition to numerous cutaneous adverse events. Cutaneous side‐effects of PD‐1 inhibitors most commonly reported in clinical trials include lichenoid reactions, eczematous dermatitis and vitiligo. What does this study add? We report two cases of PD‐1 inhibitor‐associated subacute cutaneous lupus erythematosus (SCLE), with one patient progressing to dermatomyositis with continued PD‐1 inhibitor treatment. In addition to being a novel cutaneous adverse event, we also demonstrate the possibility of development of multiple autoimmune diseases in one patient, which is different from classic drug‐related SCLE. We discuss the treatment challenges for patients with autoimmune skin disease receiving PD‐1 inhibitor therapy.

Environmental triggers of dermatomyositis: a narrative review

“…Our goal is to provide dermatologists, rheumatologists, and general practitioners with a framework for understanding and recognizing the various environmental triggers of DM in order to use this knowledge for the diagnosis, treatment, and prevention of the disease. In this narrative review we collected published peer-reviewed papers and abstracts from all available years, languages, study designs, and databases of coverage that we Review Article on Rheumatologic Skin Disease TNF-α inhibitors (6,(11)(12)(13)(14)(15)(16)(17)(18) PD-1 inhibitors (19)(20)(21)(22)(23)(24)(25) CTLA-4 inhibitors (19,26,27) Penicillamine (6,(28)(29)(30)(31) Hydroxymethylglutaryl Co-A reductase inhibitors (32,33) Lacosamide (34) Additional drugs: Phenylbutazone, Cyclophosphamide, Etoposide, Imatinib mesylate, Interferon-α2b, Omeprazole, Phenytoin, Tegaflur, Alfuzason, Etancercept, Gemfibrozil (6) Vaccinations Smallpox, diptheria and tetanus, Bacillus-Calmette-Guerin (BCG), diptheria, inactivated polio, oral cold vaccine, influenza (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) Infections Viral Parvovirus (46) Coxsackie B virus (47)…”

Systematic Review: Monoclonal Antibody-Induced Subacute Cutaneous Lupus Erythematosus

“…Thirty-seven percent of patients were treated with oral corticosteroids (18/49), either alone (n = 5) or in combination with disease-modifying antirheumatic drugs (DMARDs; n = 4), topical corticosteroids (n = 3), both these therapies (n = 5) or other immune-modulating therapies (n = 1). One patient received infliximab and oral prednisolone, but infliximab was discontinued after 5 months due to a lack of response [33]. With sun protection and topical corticosteroids added, the skin eruptions of this patient resolved within 1 month [33].…”

“…One patient received infliximab and oral prednisolone, but infliximab was discontinued after 5 months due to a lack of response [33]. With sun protection and topical corticosteroids added, the skin eruptions of this patient resolved within 1 month [33]. Thirty percent of patients received DMARDs (15/49) alone or in combination.…”

Bibliometrics Research on Immune of Traditional Chinese Medicine

“…Chinese medicine has rich experience in the prevention and treatment of the disease, especially in the immunity of traditional Chinese medicine. There are many reports have shown that immunity is related to disease [5][6][7], such as non-small cell lung cancer [8], cutaneous lupus erythematosus [9], systemic sclerosis [10], et al…”