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Faden DF, Xie L, Stone C, Lopes Almeida Gomes L, Le T, Ezeh N, Buckingham WR, Kind A, Vleugels RA, Werth VP, Arkin L, Shaw KS. Area Deprivation and Disease Severity in Adult Patients With Discoid Lupus Erythematosus. JAMA Dermatol 2024; 160:984-988. [PMID: 39046758 PMCID: PMC11270228 DOI: 10.1001/jamadermatol.2024.2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/21/2024] [Indexed: 07/25/2024]
Abstract
Importance The association of area deprivation with outcomes in discoid lupus erythematosus (DLE) remains poorly understood. Objective To determine the association between US Census block measures of deprivation and disease severity in adult patients with DLE. Design, Setting, and Participants This cross-sectional study included 154 patients with DLE seen between January 1, 2007, and January 1, 2024, at a single-center referral-based specialty rheumatologic-dermatology clinic in Philadelphia, Pennsylvania. Patients were aged 18 to 73 years and were enrolled in the University of Pennsylvania's Cutaneous Lupus Erythematosus Database study. Data were analyzed between January 1, 2024, and May 8, 2024. Exposures Residence in a highly disadvantaged area as geocoded by a state area deprivation index (ADI). Main Outcomes and Measures The main outcome was DLE disease severity as codified by the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) damage and activity scores. Results A total of 154 adult patients with DLE (128 women [83%] and 26 men [17%]; mean [SD] age, 43 [13] years; 6 [4%] Asian individuals, 98 [64%] Black individuals, 2 [1%] Hispanic individuals, 46 [30%] White individuals, and 2 individuals [1%] with other race or ethnicity; 78 [51%] with an ADI >5; 43 who currently smoked [28%];and 56 [36%] with concurrent systemic lupus erythematosus) were included in the analysis. By multivariable logistic regression, residence within communities with an ADI greater than 5 was associated with nearly 4-fold greater odds of moderate to severe damage (odds ratio [OR], 3.90; 95% CI, 1.27-12.69] and activity (OR, 3.31; 95% CI, 1.27-9.44). Concurrent cigarette smoking was similarly associated with greater odds of moderate to severe damage (OR, 3.15; 95% CI, 1.09-10.29). After controlling for ADI and other confounders, race was not significantly associated with DLE disease severity. Conclusions and Relevance The results of this cross-sectional study suggest that geospatial disadvantage is associated with DLE disease severity independent of race. This invites a paradigm shift that considers the social context within which racial disparities are observed, highlighting the potential for geographically targeted interventions and policy changes to improve patient outcomes in DLE.
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Affiliation(s)
- Daniella Forman Faden
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia
| | - Lillian Xie
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia
| | - Caroline Stone
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia
| | - Lais Lopes Almeida Gomes
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia
| | - Todd Le
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Nnenna Ezeh
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Amy Kind
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Ruth Ann Vleugels
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victoria P. Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia
| | - Lisa Arkin
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Katharina S. Shaw
- Department of Dermatology-School of Medicine, University of Pennsylvania, Philadelphia
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Mallbris MJ, Jia B, Zhao Y, Kahlenberg JM, Gudjonsson JE. Concomitant moderate-to-severe cutaneous lesions have marked impact on quality of life in patients with active systemic lupus erythematosus: a cross-sectional insight from two phase III randomized clinical trials in adults. Br J Dermatol 2024; 191:458-460. [PMID: 38687872 DOI: 10.1093/bjd/ljae183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 04/19/2024] [Accepted: 05/04/2024] [Indexed: 05/02/2024]
Abstract
For the first time and in a large study we have shown that in patients with active systemic lupus erythematosus (SLE), health-related quality of life was negatively affected by the presence of moderate-to-severe skin lesions compared with patients with active SLE who had no/mild skin lesions.
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Affiliation(s)
| | - Bochao Jia
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Youna Zhao
- Eli Lilly and Company, Indianapolis, IN, USA
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3
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Faden DF, Xie L, Stone CJ, Lopes Almeida Gomes L, Eldaboush A, Ricco C, Feng R, Werth VP. Cutaneous lupus erythematosus: Expanding clinical trial eligibility criteria based on quality of life data. J Am Acad Dermatol 2024:S0190-9622(24)02561-1. [PMID: 39094833 DOI: 10.1016/j.jaad.2024.07.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/22/2024] [Accepted: 07/13/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Daniella F Faden
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lillian Xie
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caroline J Stone
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lais Lopes Almeida Gomes
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ahmed Eldaboush
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cristina Ricco
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rui Feng
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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4
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Papachristodoulou E, Kyttaris VC. New and emerging therapies for systemic lupus erythematosus. Clin Immunol 2024; 263:110200. [PMID: 38582250 DOI: 10.1016/j.clim.2024.110200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
Systemic Lupus Erythematosus (SLE) and lupus nephritis treatment is still based on non-specific immune suppression despite the first biological therapy for the disease having been approved more than a decade ago. Intense basic and translational research has uncovered a multitude of pathways that are actively being evaluated as treatment targets in SLE and lupus nephritis, with two new medications receiving FDA approval in the last 3 years. Herein we provide an overview of targeted therapies for SLE including medications targeting the B lymphocyte compartment, intracellular signaling, co-stimulation, and finally the interferons and other cytokines.
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Affiliation(s)
- Eleni Papachristodoulou
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vasileios C Kyttaris
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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5
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Morand E, Merola JF, Tanaka Y, Gladman D, Fleischmann R. TYK2: an emerging therapeutic target in rheumatic disease. Nat Rev Rheumatol 2024; 20:232-240. [PMID: 38467779 DOI: 10.1038/s41584-024-01093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/13/2024]
Abstract
Tyrosine kinase 2 (TYK2) is a member of the JAK kinase family of intracellular signalling molecules. By participating in signalling pathways downstream of type I interferons, IL-12, IL-23 and IL-10, TYK2 elicits a distinct set of immune events to JAK1, JAK2 and JAK3. TYK2 polymorphisms have been associated with susceptibility to various rheumatic diseases including systemic lupus erythematosus and dermatomyositis. In vitro and animal studies substantiate these findings, highlighting a role for TYK2 in diseases currently managed by antagonists of cytokines that signal through TYK2. Various inhibitors of TYK2 have now been studied in human disease, and one of these inhibitors, deucravacitinib, has now been approved for the treatment of psoriasis. Phase II trials of deucravacitinib have also reported positive results in the treatment of psoriatic arthritis and systemic lupus erythematosus, with a preliminary safety profile that seems to differ from that of the JAK1, JAK2 and JAK3 inhibitors. Two other inhibitors of TYK2, brepocitinib and ropsacitinib, are also in earlier stages of clinical trials. Overall, TYK2 inhibitors hold promise for the treatment of a distinct spectrum of autoimmune diseases and could potentially have a safety profile that differs from other JAK inhibitors.
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Affiliation(s)
- Eric Morand
- Centre for Inflammatory Diseases, Monash University, and Department of Rheumatology, Monash Health, Clayton, Victoria, Australia.
| | - Joseph F Merola
- Department of Medicine, Division of Rheumatology and Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Dafna Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Division of Rheumatology University of Toronto, Toronto, Ontario, Canada
| | - Roy Fleischmann
- Metroplex Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Greco R, Alexander T, Del Papa N, Müller F, Saccardi R, Sanchez-Guijo F, Schett G, Sharrack B, Snowden JA, Tarte K, Onida F, Sánchez-Ortega I, Burman J, Castilla Llorente C, Cervera R, Ciceri F, Doria A, Henes J, Lindsay J, Mackensen A, Muraro PA, Ricart E, Rovira M, Zuckerman T, Yakoub-Agha I, Farge D. Innovative cellular therapies for autoimmune diseases: expert-based position statement and clinical practice recommendations from the EBMT practice harmonization and guidelines committee. EClinicalMedicine 2024; 69:102476. [PMID: 38361991 PMCID: PMC10867419 DOI: 10.1016/j.eclinm.2024.102476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Autoimmune diseases (ADs) are characterized by loss of immune tolerance, high chronicity, with substantial morbidity and mortality, despite conventional immunosuppression (IS) or targeted disease modifying therapies (DMTs), which usually require repeated administration. Recently, novel cellular therapies (CT), including mesenchymal stromal cells (MSC), Chimeric Antigen Receptors T cells (CART) and regulatory T cells (Tregs), have been successfully adopted in ADs. An international expert panel of the European Society for Blood and Marrow Transplantation and the International Society for the Cell and Gene Therapy, reviewed all available evidence, based on the current literature and expert practices, on use of MSC, CART and Tregs, in AD patients with rheumatological, neurological, and gastroenterological indications. Expert-based consensus and recommendations for best practice and quality of patient care were developed to support clinicians, scientists, and their multidisciplinary teams, as well as patients and care providers and will be regularly updated.
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Affiliation(s)
- Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Co-Chair of the Practice Harmonization and Guidelines Committee of EBMT and Chair of the ADWP of the EBMT, Barcelona, Spain
| | - Tobias Alexander
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Nicoletta Del Papa
- Scleroderma Clinic, Rheumatology Department, ASST G. Pini-CTO, Università degli Studi di Milano, Milano, Italy
| | - Fabian Müller
- Department of Internal Medicine 5 - Hematology and Oncology, University Hospital of Erlangen, Erlangen, Germany
- Bayrisches Zentrum für Krebsforschung (BZKF) Erlangen, Germany
| | - Riccardo Saccardi
- Cellular Therapies and Transfusion Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Fermin Sanchez-Guijo
- Department of Hematology, IBSAL-University Hospital of Salamanca and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen- Nürnberg, Erlangen, Germany
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England, United Kingdom
| | - John A. Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Karin Tarte
- SITI Lab, CHU Rennes, EFS Bretagne, University Rennes, Rennes, France
| | - Francesco Onida
- Hematology & ASCT Unit, ASST Fatebenefratelli-Sacco, University of Milan, Italy
- Co-Chair of the Practice Harmonization and Guidelines Committee of EBMT, Spain
| | - Isabel Sánchez-Ortega
- Secretary of the Practice Harmonization and Guidelines Committee of EBMT, Barcelona, Spain
- EBMT Medical Officer, Executive Office, Barcelona, Spain
| | - Joachim Burman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC, CSUR) of the Catalan and Spanish Health Systems/Member of ERN-ReCONNET, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DiMED), University of Padua, Padua, Italy
| | - Jörg Henes
- Center for Interdisciplinary Rheumatology, Immunology and Autoimmune diseases and Department of Internal Medicine II (Haematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Germany
| | - James Lindsay
- Department of Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Andreas Mackensen
- Department of Internal Medicine 5 - Hematology and Oncology, University Hospital of Erlangen, Erlangen, Germany
- Bayrisches Zentrum für Krebsforschung (BZKF) Erlangen, Germany
| | - Paolo A. Muraro
- Department of Brain Sciences, Imperial College London, London, UK
| | - Elena Ricart
- Gastroenterology Department. Hospital Clínic Barcelona. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Montserrat Rovira
- BMT Unit, Haematology Department, Institute of Haematology and Oncology, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Josep Carreras Leukaemia Research Foundation, Spain
| | - Tsila Zuckerman
- Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ibrahim Yakoub-Agha
- CHU de Lille, University Lille, INSERM U1286, Infinite, 59000, Lille, France
- Chair of the Practice Harmonization and Guidelines Committee of EBMT, Spain
| | - Dominique Farge
- Internal Medicine Unit (04): CRMR MATHEC, Maladies Auto-immunes et Thérapie Cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d’Ile-de-France, AP-HP, St-Louis Hospital Paris-Cite University, France
- Department of Medicine, McGill University, Montreal, QC, Canada
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Arnaud L, Parodis I, Devilliers H, Chasset F. Clinical trial outcomes for SLE: what we have and what we need. Lupus Sci Med 2024; 11:e001114. [PMID: 38360028 PMCID: PMC10875561 DOI: 10.1136/lupus-2023-001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
The paradigm of drug approval in SLE currently relies on successful large phase III randomised controlled trials and a set of primary, secondary and additional end points. Taken together, these outcomes offer a nuanced understanding of the efficacy and safety of the investigational agent. In this review, we thoroughly examine the main outcomes used in SLE trials and highlight unmet requirements as well as potential venues for future trial design in SLE. Disease activity indices can be broadly categorised into global-specific and organ-specific indices, in particular for skin, joints and kidneys, but there is no universal consensus about their use in clinical trials. Because each of these instruments has its own intrinsic strengths and weaknesses, the assessment of treatment response has progressed from relying solely on one individual disease activity index to using composite responder definitions. Those are typically measured from the trial baseline to the end point assessment date and may be combined with the need to taper and maintain glucocorticoids (GCs) within prespecified ranges. Remission and low disease activity are two critical states in the perspective of 'Treat-to-Target' trials, but are not fully recognised by regulators. While significant progress has been made in clinical trial outcomes for SLE, there is a clear need for continued innovation. Addressing these challenges will require collaboration between researchers, clinicians, patients as well as with regulatory agencies to refine existing outcome measures, incorporate meaningful and ethnically diverse patient perspectives, foster relevant digital opportunities and explore new therapeutic avenues, including early use of investigational agents. By doing so, we can advance our ability to manage SLE effectively and safely and improve the lives of those living with this complex and impactful autoimmune disease.
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Affiliation(s)
- Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Centre National de Référence Maladies Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Ioannis Parodis
- Service de rhumatologie, Institut Karolinska, Stockholm, Sweden
| | - Hervé Devilliers
- Servide de Médecine interne, CHU Dijon - Bourgogne, Hôpital F. MITTERRAND, Dijon, France
| | - Francois Chasset
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, and INSERM U1135, Paris, France
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Masseran C, Perray L, Murat de Montai Q, Mathian A, Teboul A, Francès C, Arnaud L, Costedoat-Chalumeau N, Amoura Z, Courvoisier DS, Barbaud A, Chasset F. Comparison of patients with isolated cutaneous lupus erythematosus versus systemic lupus erythematosus with cutaneous lupus erythematosus as the sole clinical feature: A monocentric study of 149 patients. J Am Acad Dermatol 2024:S0190-9622(24)00158-0. [PMID: 38301924 DOI: 10.1016/j.jaad.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/31/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) may present as an isolated entity or be classified as Systemic lupus erythematosus (SLE) by the presence of laboratory abnormalities, including cytopenia, low complement levels, and/or autoantibodies (CLE with laboratory SLE). OBJECTIVE To compare isolated CLE and CLE with laboratory SLE and to validate an existing 3-item score with age < 25 years (1 point), phototypes V to VI (1 point), antinuclear antibodies ≥ 1:320 (5 points) to predict the risk of progression from CLE to severe SLE (sSLE). METHODS Monocentric cohort study including consecutive patients with CLE. CLE with laboratory SLE was defined by 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for SLE score of ≥10 points at baseline with CLE as the sole clinical feature. RESULTS Of the 149 patients with CLE, 20 had CLE with laboratory SLE. The median follow-up duration was 11.3 years (IQR: 5.1-20.5). Ten patients (7%) had sSLE developed. In survival analysis, the risk of progression to sSLE was higher among CLE with laboratory SLE (hazard ratio = 6.69; 95% CI: 1.93-23.14, P < .001) compared to isolated CLE. In both groups, none of the patients with a risk score ≤ 2 had sSLE developed. LIMITATIONS Monocentric study with a limited number of patients. CONCLUSIONS CLE with laboratory patients with SLE have a higher risk of progression to sSLE than isolated CLE.
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Affiliation(s)
- Clémence Masseran
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France
| | - Laura Perray
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France
| | - Quitterie Murat de Montai
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France
| | - Alexis Mathian
- Groupement Hospitalier Pitié-Salpêtrière, Centre National de Référence du Lupus Systémique, du Syndrome des Antiphospholipides et Autres Maladies Auto-immunes, Service de Médecine Interne 2, Institut E3M, INSERM U1135, Paris, France
| | - Alexandre Teboul
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France
| | - Camille Francès
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France
| | - Laurent Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO), Université de Strasbourg
| | - Nathalie Costedoat-Chalumeau
- Université de Paris cité, Faculté de Médecine, AP-HP, Centre National de Référence Maladies Auto-immunes Systémiques, Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Zahir Amoura
- Groupement Hospitalier Pitié-Salpêtrière, Centre National de Référence du Lupus Systémique, du Syndrome des Antiphospholipides et Autres Maladies Auto-immunes, Service de Médecine Interne 2, Institut E3M, INSERM U1135, Paris, France
| | | | - Annick Barbaud
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France
| | - François Chasset
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France; INSERM U1135, CIMI, Paris, France.
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Lu X, Huang Y, Zhou M, Guo Y, Zhou Y, Wang R, Jin W, Wen C, Zhang Y, Tang Y. Artesunate attenuates serum amyloid A-induced M1 macrophage differentiation through the promotion of PHGDH. Int Immunopharmacol 2024; 127:111462. [PMID: 38159553 DOI: 10.1016/j.intimp.2023.111462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
Clinical studies indicated that Serum Amyloid A (SAA) might be a promising biomarker for forecasting the activity, severity, and adverse prognosis of systemic lupus erythematosus (SLE). Simultaneously, a positive correlation has been observed between macrophages, Th17 cells, and SLE disease activity, with both these immune cells being affected by SAA. Presently, the relationship between SAA and the aforementioned immune cell types in SLE remains to be elucidated. To discern the immune cell type most closely associated with SAA, we undertook a single-cell RNA sequencing data analysis via the GEO database. Subsequent results revealed a strong association between macrophages and SAA, a relationship further validated through flow cytometry of spleen macrophages in the MRL/lpr model. We discovered that SAA stimulate M1 macrophage differentiation along with the upregulation of pro-inflammatory cytokines such as IL-6 and IL-1β. Our findings suggest that SAA may promote M1 macrophage differentiation via the downregulation of phosphoglycerate dehydrogenase (PHGDH). Artesunate (ART), primarily utilized for malaria treatment, was shown to inhibit M1 macrophage differentiation and pro-inflammatory cytokine levels via upregulating the PHGDH expression, thereby attenuating the disease activity in SLE.
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Affiliation(s)
- Xinhui Lu
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Yan Huang
- Zhejiang Cancer Hospital, Hangzhou Institution of Medicine (HIM), Chinese Academy of Science, Hangzhou, Zhejiang 310022, China
| | - Mingqian Zhou
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Yixuan Guo
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Yihan Zhou
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Rongyun Wang
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Wumeng Jin
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Chengping Wen
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Yun Zhang
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China.
| | - Yujun Tang
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China.
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Ürün YG, Ürün M, Danişman MŞ. Dermoscopic Characteristics of Cutaneous Lupus Erythematosus According to Subtype, Lesion Location, Lesion Duration, and CLASI Score. Dermatol Pract Concept 2024; 14:dpc.1401a40. [PMID: 38364410 PMCID: PMC10868886 DOI: 10.5826/dpc.1401a40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Dermoscopic findings are used to diagnose and evaluate disease activity in patients with cutaneous lupus erythematosus (CLE). OBJECTIVES This study aimed to characterize the dermoscopic features of discoid LE (DLE) and LE tumidus (LET) by lesion duration and CLE Disease Area and Severity Index (CLASI) scores and to examine the dermoscopic findings of lesions in different locations in DLE patients. METHODS Dermoscopic findings (follicular features, perifollicular surface, interfollicular features, and vessel pattern) were assessed and lesion duration (≤12 and >12 months) and CLASI scores (grouped as mild or moderate) were calculated. DLE lesion locations were categorized as, non-scalp, scalp and lip. RESULTS Forty-eight dermoscopic images from 35 DLE and 4 LET patients were analyzed. The most common dermoscopic findings in non-scalp DLE were follicular keratotic plugs (82.8%) and white scales (69%). In scalp DLE (n=9), the most common findings were absent follicular openings (77.8%), white structureless areas (77.8%), and perifollicular scaling (66.7%). All LET patients had pink-white background and linear vessels. Follicular plugs, peripheral pigmentation, and polymorphous vessels were lower in patients with mild CLASI activity than moderate activity (P = 0.036, 0.039, and 0.019, respectively). Fibrotic white dots, honeycomb pigment pattern, and blue-gray dots/globules were lower in those with mild CLASI damage scores than moderate damage (P = 0.010, 0.010, and 0.020, respectively). Peripheral pigmentation was more common in patients with lesion duration ≤12 months, while blue-gray dots/globules were more common with lesion durations >12 months. CONCLUSIONS Certain dermoscopic features may facilitate the differential diagnosis of DLE and LET.
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Affiliation(s)
- Yıldız Gürsel Ürün
- Departments of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mustafa Ürün
- Departments of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mehmet Şerif Danişman
- Departments of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
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Cruciani C, Zen M, Gatto M, Morand E, Doria A. Assessment of disease activity and damage in SLE: Are we there yet? Best Pract Res Clin Rheumatol 2023; 37:101896. [PMID: 38044231 DOI: 10.1016/j.berh.2023.101896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
Systemic Lupus Erythematosus is a systemic autoimmune disease characterized by a great heterogenicity in course and clinical manifestations. Although prognosis improved in the last decades of the 20th century, mortality remains higher than in the general population and uncontrolled disease activity and therapy-related adverse effects have been identified as major contributors to damage accrual and poor outcomes. Assessment of disease activity and damage in SLE represents a great challenge even to the expert rheumatologist. Global disease activity indices are tools developed to assess activity across multiple organ systems. Several disease activity indices have been developed over the years, each with its own strengths and weaknesses, and knowing them is essential for understanding research studies, such as clinical trials, in which they are used. Organ-specific activity indices have been developed concurrently to represent organ involvement such as glomerulonephritis, cutaneous and musculoskeletal lupus manifestations. Regarding damage, the SLICC/ACR damage index has proven to be an effective tool for damage accrual assessment, yet not devoid of drawbacks. This review provides an overview of the most frequently utilized indices developed for the assessment of activity and damage in SLE highlighting their pros and cons when applied to the research and clinical setting.
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Affiliation(s)
- Claudio Cruciani
- Division of Rheumatology, Department of Internal Medicine, Azienda Ospedaliera di Padova, University of Padova, Padova, Veneto, Italy.
| | - Margherita Zen
- Division of Rheumatology, Department of Internal Medicine, Azienda Ospedaliera di Padova, University of Padova, Padova, Veneto, Italy.
| | - Mariele Gatto
- Rheumatology Unit, Department of Clinical and Biological Sciences, University of Turin and Turin Mauriziano Hospital, Turin, Italy.
| | - Eric Morand
- Centre for Inflammatory Diseases, Monash University, Rheumatology Unit, Monash Health, Melbourne, Australia.
| | - Andrea Doria
- Division of Rheumatology, Department of Internal Medicine, Azienda Ospedaliera di Padova, University of Padova, Padova, Veneto, Italy.
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12
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McCormick ET, Draganski A, Chalmers S, Zahn J, Garcia S, Nussbaum D, Friedman A, Putterman C, Friedman J. Nano-encapsulated anandamide reduces inflammatory cytokines in vitro and lesion severity in a murine model of cutaneous lupus erythematosus. Exp Dermatol 2023; 32:2072-2083. [PMID: 37726950 DOI: 10.1111/exd.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune skin disease which occurs independently and in conjunction with systemic lupus erythematosus. Drug development for CLE is severely lacking. Anandamide (AEA) is a primary endocannabinoid which exhibits immunomodulatory effects through mixed cannabinoid receptor agonism. We evaluated AEA as topical treatment for CLE and assessed benefits of nanoparticle encapsulation (AEA-NP) on cutaneous drug penetration, delivery and biological activity. Compared to untreated controls, AEA-NP decreased IL-6 and MCP-1 in UVB-stimulated keratinocytes (p < 0.05) in vitro. In BALB/c mice, AEA-NP displayed improved cutaneous penetration, extended release and persistence of AEA in the follicular unit extending to the base after 24 h. Utilizing the MRL-lpr lupus murine model, twice weekly treatment of lesions with topical AEA-NP for 10 weeks led to decreased clinical and histologic lesion scores compared to unencapsulated AEA and untreated controls (p < 0.05). Prophylactic application of AEA-NP to commonly involved areas on MRL-lpr mice similarly resulted in decreased clinical and histologic scores when compared to controls (p < 0.05), and reduced C3 and IBA-1 in lesional tissue (p < 0.05). The demonstrated clinical and immunomodulatory effects of treatment with AEA support its potential as therapy for CLE. This work also suggests that encapsulation of AEA improves penetration and treatment efficacy. Future studies will be conducted to assess full therapeutic potential.
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Affiliation(s)
- Erika T McCormick
- George Washington University Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Samantha Chalmers
- Division of Rheumatology, Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, Bronx, USA
| | - Joseph Zahn
- George Washington University Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sayra Garcia
- Division of Rheumatology, Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, Bronx, USA
| | - Dillon Nussbaum
- George Washington University Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Adam Friedman
- George Washington University Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Chaim Putterman
- Division of Rheumatology, Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, Bronx, USA
- Azrieli Faculty of Medicine of Bar-Ilan University, Zefat, Israel
- Research Institute, Galilee Medical Center, Nahariya, Israel
| | - Joel Friedman
- Division of Rheumatology, Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, Bronx, USA
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13
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Heide M, von Figura A, Rademacher JG, Wincup C, Tampe B, Korsten P. Steroid-free flare management of a severe cutaneous lupus flare with anifrolumab. Lupus 2023; 32:1585-1587. [PMID: 37885415 DOI: 10.1177/09612033231210398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Marielle Heide
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea von Figura
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Chris Wincup
- Department of Rheumatology, King's College Hospital, London, UK
- Department of Rheumatology, Division of Medicine, Rayne Building, University College London, London, UK
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- Department of Rheumatology and Clinical Immunology, St Josef-Stift Sendenhorst, Sendenhorst, Germany
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14
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Ismail SA, Awad SM, Gamal RM, Gaber MA, Hussein SM, Hammam N. Serum pentraxin 3 in systemic lupus erythematosus: A potential indicator of cutaneous disease activity. Lupus 2023:9612033231175627. [PMID: 37183233 DOI: 10.1177/09612033231175627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Although skin manifestations are common in systemic lupus erythematosus (SLE), there is still a lack of a diagnostic marker for cutaneous involvement. Pentraxin3 (PTX3) has been studied in SLE patients; however, it has not been investigated in relation to cutaneous manifestations. OBJECTIVE To assess the serum PTX3 level in SLE patients, and to investigate its relationship with disease activity as well as with variable skin manifestations. PATIENTS AND METHODS Thirty-four patients with SLE (17 patients with skin manifestations and 17 without) and 30 healthy subjects were included in the study. Patients were evaluated clinically for systemic and skin manifestations of SLE. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2k) and Cutaneous Lupus Erythematosus Activity and Severity Index (CLASI) scores were calculated. Serum level of PTX3 was measured in patients and controls using ELISA. RESULTS Higher serum PTX3 level was found in SLE patients compared to controls (p < 0.001). Patients with skin manifestations showed higher SLEDAI-2k scores and had higher PTX3 level compared to those without skin manifestations (p = 0.015 and p < 0.001, respectively). PTX3 showed higher levels in association with malar rash (p < 0.001), mucosal ulcers (p < 0.001), alopecia (p < 0.001), and purpuric eruption (p = 0.002). Moreover, PTX3 level positively correlated with CLASI scores (p < 0.001). CONCLUSION Our results reinforce the important role of Pentraxin3 in SLE patients with skin manifestations, and it may be considered an interesting biomarker for the pattern and extent of cutaneous involvement in SLE.
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Affiliation(s)
- Sahar A Ismail
- Department of Dermatology and Venereology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sara M Awad
- Department of Dermatology and Venereology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Rania M Gamal
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Marwa A Gaber
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Safaa M Hussein
- Department of Dermatology and Venereology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nevin Hammam
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
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15
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Cho SK, Vazquez T, Werth VP. Litifilimab (BIIB059), a promising investigational drug for cutaneous lupus erythematosus. Expert Opin Investig Drugs 2023:1-9. [PMID: 37148249 DOI: 10.1080/13543784.2023.2212154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
INTRODUCTION There are no U.S. Food and Drug Administration (FDA) approved therapies for cutaneous lupus erythematosus (CLE). Litifilimab is a monoclonal antibody against BDCA2, a plasmacytoid dendritic cell specific antigen, currently under investigation for systemic lupus erythematosus (SLE) and CLE. The LILAC study, published in the New England Journal of Medicine, is a phase II randomized controlled trial for CLE which demonstrated superiority of Litifilimab over placebo using a skin directed outcome measure. AREAS COVERED This review identifies challenges that have hindered the development of any approved treatments for CLE, recent SLE trials that include skin disease data, and the pharmacological properties of litifilimab. We review the clinical efficacy and safety of litifilimab for both SLE and CLE in the phase I and II clinical trials. This review aims to highlight the need for more CLE specific clinical trials and examine the potential of litifilimab as the first FDA approved therapy for CLE. (Clinical trial registration: www.clinicaltrials.gov identifier is NCT02847598.). EXPERT OPINION Litifilimab demonstrated efficacy in a randomized phase II clinical trial as a standalone CLE trial using validated skin specific outcome measures, making it the first successful clinical trial for a CLE targeted therapy. If approved, litifilimab will be a pivotal change in the landscape of CLE management especially for severe and refractory disease.
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Affiliation(s)
- Sung Kyung Cho
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas Vazquez
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Victoria P Werth
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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16
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Shaw K, Sanchez-Melendez S, Taylor D, Barker J, LaChance A, Shahriari N, Vleugels RA. Assessment of Clinical Response to Anifrolumab in Patients With Refractory Discoid Lupus Erythematosus. JAMA Dermatol 2023; 159:560-563. [PMID: 36920401 PMCID: PMC10018404 DOI: 10.1001/jamadermatol.2023.0175] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/20/2023] [Indexed: 03/16/2023]
Abstract
This case series examines the efficacy of anifrolumab as a therapeutic option for patients with lupus erythematosus.
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Affiliation(s)
- Katharina Shaw
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Dustin Taylor
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia Barker
- Division of Dermatology, University of Vermont Medical Center, Burlington
| | - Avery LaChance
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neda Shahriari
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Buie J, Bloch L, Morand EF, van Vollenhoven RF, Werth VP, Touma Z, Lipsky P, Kalunian K, Askanase AD, Ines L, Reed C, Son M, Franson T, Costenbader K, Schanberg LE. Meeting report: the ALPHA project: a stakeholder meeting on lupus clinical trial outcome measures and the patient perspective. Lupus Sci Med 2023; 10:e000901. [PMID: 37537705 PMCID: PMC9930541 DOI: 10.1136/lupus-2023-000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
Drug development in lupus has improved over the past 10 years but still lags behind that of other rheumatic disease areas. Assessment of prospective lupus therapies in clinical trials has proved challenging for reasons that are multifactorial including the heterogeneity of the disease, study design limitations and a lack of validated biomarkers which greatly impacts regulatory decision-making. Moreover, most composite outcome measures currently used in trials do not include patient-reported outcomes. Given these factors, the Addressing Lupus Pillars for Health Advancement Global Advisory Committee members who serve on the drug development team identified an opportunity to convene a meeting to facilitate information sharing on completed and existing outcome measure development efforts. This meeting report highlights information presented during the meeting as well as a discussion on how the lupus community may work together with regulatory agencies to simplify and standardise outcome measures to accelerate development of lupus therapeutics.
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Affiliation(s)
- Joy Buie
- Research, Lupus Foundation of America, Washington, District of Columbia, USA
| | - Lauren Bloch
- Health Policy and Regulatory Affairs, Faegre Drinker Biddle and Reath LLP Washington, Washington, District of Columbia, USA
| | - Eric F Morand
- Rheumatology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center ARC, Amsterdam, The Netherlands
| | - Victoria P Werth
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zahi Touma
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Lipsky
- RILITE Research Institute, Charlottesville, Virginia, USA
| | | | - Anca D Askanase
- Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - L Ines
- Faculty of Health Sciences, Univ Beira Interior, Covilha, Portugal
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - MaryBeth Son
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Karen Costenbader
- Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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18
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Nouh AH, Elshahid AR, Kadah AS, Zeyada YA. Topical niacinamide (Nicotinamide) treatment for discoid lupus erythematosus (DLE): A prospective pilot study. J Cosmet Dermatol 2023; 22:1647-1657. [PMID: 36683259 DOI: 10.1111/jocd.15628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cutaneous lupus erythematosus is an umbrella term for a group of autoimmune connective tissue disorders affecting the skin. Discoid lupus erythematosus (DLE) is the chronic condition and most common form of cutaneous lupus erythematosus. AIMS Current therapies of DLE are challenging and not completely satisfactory, highly expensive, off-label, or poorly available (like antimalarials due to COVID-19 outbreaks). Nicotinamide, also called niacinamide, is a water-soluble form of vitamin B3 (niacin). Its multiple effects let us think that nicotinamide could be a therapy for lupus-associated skin lesions. METHODS We performed a prospective randomized double-blind clinical trial on 60 subjects diagnosed with Discoid lupus erythematosus using topical Nicotinamide 2% and 4% preparations in form of cream and gel on skin and scalp lesions. Control group was included using only cream/gel base as placebo control. RESULTS Obtained data showed that topical Nicotinamide can be used for the treatment of DLE as adjuvant to other treatment regimens with good cosmetic results and minimal side effects. Topical 4% Nicotinamide is superior to 2% preparation in response but associated with a higher incidence of irritation. CONCLUSION Topical Nicotinamide can be used for the treatment of DLE as an adjuvant to other treatment regimens with good cosmetic results and minimal side effects. Further trials with long-term therapy, follow-up period, and bigger sample sizes are required.
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Affiliation(s)
- Ahmed H Nouh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine of Al-Azhar University, Cairo, Egypt
| | - Ahmed R Elshahid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine of Al-Azhar University, Cairo, Egypt
| | - Ahmed S Kadah
- Dermatology and Venereology at Al-Hussein University Hospital of Al-Azhar University, Cairo, Egypt
| | - Youssef A Zeyada
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine of Al-Azhar University, Cairo, Egypt
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Alsuwayegh A, Almaghlouth IA, Almasaoud MA, Alzaid AS, Alsuhaibani AA, Almana LH, Alabdulkareem SM, Abudahesh JA, AlRuthia Y. Cost Consequence Analysis of Belimumab versus Standard of Care for the Management of Systemic Lupus Erythematosus in Saudi Arabia: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1917. [PMID: 36767283 PMCID: PMC9915237 DOI: 10.3390/ijerph20031917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Belimumab use for the management of systemic lupus erythematosus (SLE) has been limited, in part due to its high acquisition cost relative to the standard of care (SoC) and the uncertainties about its cost-effectiveness. Therefore, the aim of this study was to compare the cost and effectiveness of belimumab versus the SoC alone for the management of SLE using real-world data from the perspective of public healthcare payers in Saudi Arabia. METHODS Data were retrieved from a national prospective cohort of SLE, Saudi Arabia. Adult SLE patients (≥18 yrs.) treated with belimumab plus the SoC or the SoC alone for at least six months were recruited. The effectiveness was measured using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Unit costs for health services and prescription drugs were retrieved from the Saudi ministry of health. Nonparametric bootstrapping with inverse probability weighting was conducted to generate the 95% confidence limits for the cost and effectiveness. RESULTS A total of 15 patients on belimumab plus the SoC and 41 patients on the SoC alone met the inclusion criteria and were included in the analysis. The majority of patients were females (91.07%) with a mean age of 38 years. The mean difference in cost and SLEDAI-2K score reduction between belimumab versus the SoC were USD 5303.16 [95% CI: USD 2735.61-USD 7802.52] and 3.378 [95% CI: 1.769-6.831], respectively. Belimumab demonstrated better effectiveness but higher cost in 96% of the bootstrap cost-effectiveness distributions. CONCLUSION Future studies should use more robust research designs and a larger sample size to confirm the findings of this study.
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Affiliation(s)
- Aseel Alsuwayegh
- Corporate Department of Pharmacy Services, King Saud University Medical City, Riyadh 11451, Saudi Arabia
| | - Ibrahim A. Almaghlouth
- Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | | | | | | | | | | | | | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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20
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Abbas LF, Nandy K, Chong BF. Classification of disease damage and activity in cutaneous lupus erythematosus: A cross-sectional analysis. J Am Acad Dermatol 2023; 88:219-221. [PMID: 35513177 PMCID: PMC9626392 DOI: 10.1016/j.jaad.2022.04.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Laila F Abbas
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Karabi Nandy
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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21
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Gaffney RG, Werth VP, Merola JF. Cutaneous lupus erythematosus disease assessment: Highlighting CLE outcome measures. Front Med (Lausanne) 2022; 9:968469. [PMID: 36314023 PMCID: PMC9614355 DOI: 10.3389/fmed.2022.968469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Victoria P. Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States,Corporal Michael J. Crescenz Veteran's Administration Medical Center (VAMC), Philadelphia, PA, United States
| | - Joseph F. Merola
- Harvard Combined Dermatology Program, Boston, MA, United States,Division of Rheumatology, Department of Dermatology and Medicine, Brigham and Women's Hospital, Boston, MA, United States,*Correspondence: Joseph F. Merola
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22
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Sprow G, Dan J, Merola JF, Werth VP. Emerging Therapies in Cutaneous Lupus Erythematosus. Front Med (Lausanne) 2022; 9:968323. [PMID: 35899214 PMCID: PMC9313535 DOI: 10.3389/fmed.2022.968323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous lupus erythematosus (CLE) is an autoimmune disease that can occur with or without underlying systemic lupus erythematosus (SLE) and often has a profoundly negative impact on patient quality of life. There is substantial need for new and more effective therapies to treat CLE. CLE has a multifactorial pathogenesis that involves several key immune cells and pathways, including abnormalities in innate (e.g., type 1 interferon pathways) and adaptive immune responses (e.g., B and T cell autoreactivity), presenting multiple opportunities for more targeted therapies that do not require immunosuppression. Here we review several emerging therapies and their efficacy in CLE. Anifrolumab and belimumab have both been approved for the treatment of SLE in recent years, and clinical trial evidence suggests some forms of CLE may improve with these agents. Therapies currently in development that are being evaluated with CLE-specific outcome measures include BIIB059 and VIB7734, which target plasmacytoid dendritic cells (pDCs), and iberdomide, a cereblon modulator. These novel therapies all have previously demonstrated clinical benefit in some forms of CLE. Other therapies which target molecules believed to play a role in CLE pathogenesis, such as Janus kinases (JAKs), spleen tyrosine kinase (SYK), interferon γ (IFNγ), IL-12, and IL-23, have been evaluated in lupus clinical trials with skin-specific outcomes but failed to meet their primary endpoints.
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Affiliation(s)
- Grant Sprow
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Joshua Dan
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Joseph F. Merola
- Department of Dermatology, Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Victoria P. Werth
- Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- *Correspondence: Victoria P. Werth
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23
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Effect of add-on hydroxychloroquine therapy on serum proinflammatory cytokine levels in patients with systemic lupus erythematosus. Sci Rep 2022; 12:10175. [PMID: 35715525 PMCID: PMC9205904 DOI: 10.1038/s41598-022-14571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
We investigated the effect of hydroxychloroquine (HCQ) as an add-on treatment to immunosuppressants on the expression of proinflammatory cytokines in patients with systemic lupus erythematosus. Serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-2, IL-6, IL-8, vascular endothelial growth factor (VEGF)-A, monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), and interleukin 1 receptor antagonist (IL-1ra) were measured immediately before and 3 months after treatment with oral HCQ. Among the 51 patients enrolled in the study, HCQ treatment led to significantly reduced serum levels of TNF-α, IL-6, IL-8, VEGF-A, IL-1ra, and IL-2 (p < 0.0001; p = 0.0006; p = 0.0460, p = 0.0177; p < 0.0001; p = 0.0282, respectively) and to decreased (but not significantly) levels of MIP-1α (p = 0.0746). No significant changes were observed in the serum MCP-1 levels before and after HCQ administration (p = 0.1402). Our results suggest that an add-on HCQ treatment modulates the expression of proinflammatory cytokines even in systemic lupus erythematosus patients with low disease activity.
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24
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Plüß M, Piantoni S, Wincup C, Korsten P. Rapid Response of Refractory Systemic Lupus Erythematosus Skin Manifestations to Anifrolumab-A Case-Based Review of Clinical Trial Data Suggesting a Domain-Based Therapeutic Approach. J Clin Med 2022; 11:3449. [PMID: 35743519 PMCID: PMC9225134 DOI: 10.3390/jcm11123449] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease, and organ manifestations, such as lupus nephritis (LN) or skin disease, may be refractory to standard treatment. Therefore, new agents are required to allow for a more personalized therapeutic approach. Recently, several new therapies have been approved internationally, including voclosporine for LN and anifrolumab for moderately to severely active SLE. Here, we report a case of SLE with a predominant and refractory cutaneous manifestation despite combination treatment with glucocorticoids, hydroxychloroquine, mycophenolate mofetil, and belimumab, which had been present for more than 12 months. Belimumab was switched to anifrolumab, and the patient responded quickly after two infusions (eight weeks) with a reduction in the Cutaneous Lupus Assessment and Severity Index (CLASI) from 17 to 7. In addition, we review the available clinical trial data for anifrolumab with a focus on cutaneous outcomes. Based on phase II and III clinical trials investigating the intravenous administration, a consistent CLASI improvement was observed at 12 weeks. Interestingly, in a phase II trial of subcutaneous anifrolumab application, CLASI response was not different from placebo at 12 weeks but numerically different at 24 and 52 weeks, respectively. Thus, anifrolumab emerges as an attractive new therapeutic option suggesting a possible domain-based approach.
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Affiliation(s)
- Marlene Plüß
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany;
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25121 Brescia, Italy;
| | - Chris Wincup
- Department of Rheumatology, King’s College Hospital, London SE5 9RS, UK;
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany;
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25
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Billi AC, Ma F, Plazyo O, Gharaee-Kermani M, Wasikowski R, Hile GA, Xing X, Yee CM, Rizvi SM, Maz MP, Berthier CC, Wen F, Tsoi LC, Pellegrini M, Modlin RL, Gudjonsson JE, Kahlenberg JM. Nonlesional lupus skin contributes to inflammatory education of myeloid cells and primes for cutaneous inflammation. Sci Transl Med 2022; 14:eabn2263. [PMID: 35476593 PMCID: PMC9169615 DOI: 10.1126/scitranslmed.abn2263] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cutaneous lupus erythematosus (CLE) is a disfiguring and poorly understood condition frequently associated with systemic lupus. Previous studies suggest that nonlesional keratinocytes play a role in disease predisposition, but this has not been investigated in a comprehensive manner or in the context of other cell populations. To investigate CLE immunopathogenesis, normal-appearing skin, lesional skin, and circulating immune cells from lupus patients were analyzed via integrated single-cell RNA sequencing and spatial RNA sequencing. We demonstrate that normal-appearing skin of patients with lupus represents a type I interferon-rich, prelesional environment that skews gene transcription in all major skin cell types and markedly distorts predicted cell-cell communication networks. We also show that lupus-enriched CD16+ dendritic cells undergo robust interferon education in the skin, thereby gaining proinflammatory phenotypes. Together, our data provide a comprehensive characterization of lesional and nonlesional skin in lupus and suggest a role for skin education of CD16+ dendritic cells in CLE pathogenesis.
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Affiliation(s)
| | - Feiyang Ma
- Dept of Molecular, Cell, and Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
| | - Olesya Plazyo
- Dept of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Mehrnaz Gharaee-Kermani
- Dept of Dermatology, University of Michigan, Ann Arbor, MI, USA.,Division of Rheumatology, Dept of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Grace A. Hile
- Dept of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Xianying Xing
- Dept of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Christine M. Yee
- Dept of Chemical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Syed M. Rizvi
- Dept of Chemical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Mitra P. Maz
- Division of Rheumatology, Dept of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Celine C. Berthier
- Division of Nephrology, Dept of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Fei Wen
- Dept of Chemical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Lam C. Tsoi
- Dept of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Matteo Pellegrini
- Dept of Molecular, Cell, and Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert L. Modlin
- Dept of Molecular, Cell, and Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - J. Michelle Kahlenberg
- Dept of Dermatology, University of Michigan, Ann Arbor, MI, USA.,Division of Rheumatology, Dept of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Corresponding author: J. Michelle Kahlenberg, MD, PhD,
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26
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Zhou AE, Shaikh G, Driscoll MS. Discoid lupus erythematosus of the palms: A case report. Clin Case Rep 2022; 10:e05048. [PMID: 35474981 PMCID: PMC9033645 DOI: 10.1002/ccr3.5048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 12/02/2022] Open
Abstract
Discoid lupus erythematosus is an autoimmune connective‐tissue disease that represents a subset of conditions on the cutaneous lupus spectrum. The lesions are characterized by disk‐shaped plaques on photo‐exposed skin with inflammatory hyperpigmentation and adherent scale. Here, we present a patient with a rare manifestation of discoid lesions on the palms.
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Affiliation(s)
- Albert E. Zhou
- Department of Dermatology University of Maryland School of Medicine Baltimore Maryland USA
| | - Gibran Shaikh
- Department of Dermatology University of Maryland School of Medicine Baltimore Maryland USA
| | - Marcia S. Driscoll
- Department of Dermatology University of Maryland School of Medicine Baltimore Maryland USA
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27
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Fayard D, Francès C, Amoura Z, Breillat P, Mathian A, Senet P, Barbaud A, Arnaud L, Chasset F. Prevalence and factors associated with long-term remission in cutaneous lupus: a longitudinal cohort study of 141 cases. J Am Acad Dermatol 2022; 87:323-332. [PMID: 35390427 DOI: 10.1016/j.jaad.2022.03.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about the prevalence and factors associated with long-term remission in cutaneous lupus erythematosus (CLE). OBJECTIVES To assess the prevalence, the factors associated with remission and long-term remission with and without treatment during CLE. METHODS Longitudinal cohort study including biopsy proven CLE patients seen between November 1st, 2019, and April 30th, 2021, with at least 6 months of follow-up after diagnosis. Demographic data, CLE subtypes, remission status and treatments were recorded. Remission was defined by a Cutaneous LE Disease Area and Severity Index activity (CLASI-A) score of 0. Long-term remission was defined by remission > 3 years. RESULTS Among 141 patients included (81% of women), 93 (66%) were in remission at last follow-up with a median duration since diagnosis of 11.4 years (IQR 4.2-24.7). Long-term remission was observed in 22 (19%) of 114 patients with at least 3 years of follow-up, including 5 (4.4%) with no systemic treatment. Active smoking (OR: 0.22 [95%CI: 0.05-0.97], p=0.04) and DLE lesions (OR: 0.14 [95%CI: 0.04-0.48], p=0.004) were associated with a lower risk of long-term remission. LIMITATIONS Partial retrospective data collection and tertiary center population. CONCLUSION Long-term remission is rare in CLE and negatively associated with active smoking and DLE.
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Affiliation(s)
- Damien Fayard
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France; CHU Gabriel Montpied, Service de Médecine Interne, Clermont-Ferrand, France
| | - Camille Francès
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France
| | - Zahir Amoura
- Sorbonne Université, Faculté de Médecine, AP-HP, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Paul Breillat
- Sorbonne Université, Faculté de Médecine, AP-HP, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Alexis Mathian
- Sorbonne Université, Faculté de Médecine, AP-HP, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Patricia Senet
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France
| | - Annick Barbaud
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France
| | - Laurent Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO), Université de Strasbourg, France
| | - François Chasset
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France.
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28
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Amudzi AA, Piedra-Mora C, Ma DJ, Wong NB, David CN, Robinson NA, Almela RM, Richmond JM. Using Gene Expression Analysis to Understand Complex Autoimmune Skin Disease Patients: A Series of Four Canine Cutaneous Lupus Erythematosus Cases. Front Vet Sci 2022; 9:778934. [PMID: 35280134 PMCID: PMC8907585 DOI: 10.3389/fvets.2022.778934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous Lupus Erythematosus (CLE) is an autoimmune skin disease that occurs in almost two-thirds of people with Systemic Lupus Erythematosus (SLE) and can exist as its own entity. Despite its negative impact on the quality of life of patients, lupus pathogenesis is not fully understood. In recent years, the role of gene expression analysis has become important in understanding cellular functions and disease causation within and across species. Interestingly, dogs also develop CLE, providing a spontaneous animal model of disease. Here, we present a targeted transcriptomic analysis of skin biopsies from a case series of four dogs with complex autoimmunity with suspected CLE. We identified 92 differentially expressed genes (DEGs), including type 1 interferon, B cell, and T cell-related genes, in the four cases compared to healthy skin margin controls. Additionally, we compared our results with existing CLE datasets from humans and mice and found that humans and canines share 49 DEGs, whereas humans and mice shared only 25 DEGs in our gene set. Immunohistochemistry of IFNG and CXCL10, two of the most highly upregulated inflammatory mediators, confirmed protein-level expression and revealed immune cells as the primary source of CXCL10 in dogs with SLE, whereas keratinocytes stained strongly for CXCL10 in dogs without SLE. We propose that gene expression analysis may aid the diagnosis of complex autoimmune skin diseases and that dogs may provide important insights into CLE and SLE pathogeneses, or more broadly, skin manifestations during systemic autoimmunity.
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Affiliation(s)
- Alice A. Amudzi
- Dermatology Department, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Cesar Piedra-Mora
- Pathology Department, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, United States
| | - Diana Junyue Ma
- Dermatology Department, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Neil B. Wong
- Dermatology Department, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | | | - Nicholas A. Robinson
- Pathology Department, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, United States
| | - Ramón M. Almela
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, United States
| | - Jillian M. Richmond
- Dermatology Department, University of Massachusetts Chan Medical School, Worcester, MA, United States
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29
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Furie RA, Hough DR, Gaudy A, Ye Y, Korish S, Delev N, Weiswasser M, Zhan X, Schafer PH, Werth VP. Iberdomide in patients with systemic lupus erythematosus: a randomised, double-blind, placebo-controlled, ascending-dose, phase 2a study. Lupus Sci Med 2022; 9:9/1/e000581. [PMID: 35169036 PMCID: PMC8852715 DOI: 10.1136/lupus-2021-000581] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/14/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate safety, pharmacokinetics, pharmacodynamics and efficacy of iberdomide in patients with SLE. Iberdomide is a high-affinity cereblon ligand that targets the hematopoietic transcription factors Ikaros and Aiolos for proteasomal degradation. METHODS A 12-week, multicentre, double-blind, placebo-controlled, dose-escalation study in active SLE was followed by a 2-year, open-label active treatment extension phase (ATEP) (NCT02185040). In the dose-escalation phase, adults with active SLE were randomised to oral placebo or iberdomide (0.3 mg every other day, 0.3 mg once daily, 0.6 mg and 0.3 mg alternating once daily, or 0.6 mg once daily). Primary endpoints were safety and tolerability. RESULTS The dose-escalation phase enrolled 42 patients, with 33 completing this phase and 17 patients enrolling into the ATEP. In the dose-escalation phase, the most common treatment-emergent adverse events (TEAEs; iberdomide/placebo groups) were nausea (20.6%/12.5%), diarrhoea (17.6%/12.5%) and upper respiratory tract infection (11.8%/12.5%). Most TEAEs were mild or moderate in severity and more common in the highest dose groups in both study phases. In the dose-escalation phase, Physician's Global Assessment and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) activity scores improved relative to baseline and placebo in all iberdomide groups, with a trend toward continued score improvements in the ATEP. In the dose-escalation phase, iberdomide treatment resulted in dose-dependent reductions in total B cells and plasmacytoid dendritic cells in blood. Improvements in CLASI activity scores correlated with plasmacytoid dendritic cell depletion. CONCLUSIONS These proof-of-concept findings suggest a favourable benefit/risk ratio in SLE for iberdomide, a drug with a novel immunomodulatory mechanism of action, supporting further clinical investigation.
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Affiliation(s)
| | - Douglas R Hough
- Clinical Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Allison Gaudy
- Translational Development, Clinical Pharmacology, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Ying Ye
- ICF Early Clinical Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Shimon Korish
- Clinical R&D, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Nikolay Delev
- Clinical R&D, Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Xiaojiang Zhan
- Biometrics, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Peter H Schafer
- TRC Inflammation, CV & Fibrosis and Global Health, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Victoria P Werth
- Corporal Michael J Crescenz VA Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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30
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31
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Peh D, Wan Ahmad Kammal WSL, Beh PJ, Yong ACH, Tan WC, Lim AL, Thevarajah S, Stanslas J, How KN. Correlation of whole blood hydroxychloroquine concentration with cutaneous lupus erythematosus and factors associated with it: First multicenter, cross-sectional analysis in Malaysia. J Dermatol 2022; 49:545-549. [PMID: 35067938 DOI: 10.1111/1346-8138.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
Hydroxychloroquine (HCQ) is the first-line systemic treatment for cutaneous lupus erythematosus (CLE). Whole blood HCQ concentration (WBHCQ) was found to correlate with CLE severity among Caucasians. However, studies on Asians are scarce. We aim to explore the relationship of WBHCQ with CLE disease activity among multi-racial Malaysians and the factors associated with WBHCQ. A cross-sectional study targeting patients with CLE was conducted from 1 June till 30 November 2019. Disease activity was assessed using Cutaneous Lupus Erythematosus Disease Area and Severity Index - Activity Score (CLASI-AS). Blood was analyzed for WBHCQ concentration using a high-performance liquid chromatography technique. Statistical analysis was done using R studio version 1.2.1335. A total of 88 subjects (male : female, 4.5:1) with a median age of 41 years old were recruited. The median duration CLE was 5 years. The majority had acute cutaneous lupus (n = 45, 51.1%). The median WBHCQ was 946.8 ng/mL. Indians were found to have the highest WBHCQ (median ± interquartile range [IQR], 1515.4 ± 1494.8 ng/mL). Males had a lower WBHCQ (median ± IQR, 733.5 ± 573.8 ng/mL) than females (995.5 ± 925.1 ng/mL). However, no statistically significant association between race and sex with WBHCQ was demonstrable (p = 0.247, p = 0.066). No correlation was demonstrated between WBHCQ and CLASI-AS (r = -0.02, p = 0.851). A positive correlation was found between HCQ dosage (ideal bodyweight) and WBHCQ (r = 0.24, p = 0.027). No other factors were found associated with WBHCQ. Indians and females were observed to have higher WBCHQ; however, no significant correlation was identified. Further study is required to confirm the finding.
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Affiliation(s)
- D Peh
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - W S L Wan Ahmad Kammal
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Hospital Pengajar Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - P J Beh
- Faculty of Pharmacy, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - A C H Yong
- Faculty of Pharmacy, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia
| | - W C Tan
- Department of Dermatology, Hospital Pulau Pinang, George Town, Pulau Pinang, Malaysia
| | - A L Lim
- Rheumatology Unit, Department of Medicine, Hospital Pulau Pinang, George Town, Pulau Pinang, Malaysia
| | - S Thevarajah
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - J Stanslas
- Pharmacotherapeutic Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Kang Nien How
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Hospital Pengajar Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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32
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Guo LN, Perez-Chada LM, Borucki R, Nambudiri VE, Werth VP, Merola JF. Development of a working core outcome set for cutaneous lupus erythematosus: a practical approach to an urgent unmet need. Lupus Sci Med 2022; 8:8/1/e000529. [PMID: 34969875 PMCID: PMC8718411 DOI: 10.1136/lupus-2021-000529] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022]
Abstract
Objective The lack of standardised outcomes and outcome measures for cutaneous lupus erythematosus (CLE) represents a substantial barrier to clinical trial design, comparative analysis and approval of novel investigative treatments. We aimed to develop a working core outcome set (COS) for CLE randomised controlled trials and longitudinal observational studies. Methods We conducted a multistage literature review of CLE and SLE studies to generate candidate domains and outcome measures. Domains were narrowed to a working core domain set. Outcome measures for core domains were identified and examined. Results Proposed core domains include skin-specific disease activity and damage, investigator global assessment (IGA) of disease activity, symptoms (encompassing itch, pain and photosensitivity), health-related quality of life (HRQoL) and patient global assessment (PtGA) of disease activity. Recommended physician-reported outcome measures include the Cutaneous Lupus Erythematous Disease Area and Severity Index (CLASI) and Cutaneous Lupus Activity IGA (CLA-IGA). For the domains of symptoms, HRQoL and PtGA of disease activity, we were unable to recommend one clearly superior instrument. Conclusion This work represents a starting point for further refinement pending formal consensus activities and more rigorous evaluations of outcome measure quality. In the interim, the proposed working COS can serve as a much-needed guide for upcoming CLE clinical trials.
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Affiliation(s)
- Lisa N Guo
- Dermatology and Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Lourdes M Perez-Chada
- Harvard Medical School, Boston, Massachusetts, USA.,Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Robert Borucki
- Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Vinod E Nambudiri
- Harvard Medical School, Boston, Massachusetts, USA.,Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria P Werth
- Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joseph F Merola
- Harvard Medical School, Boston, Massachusetts, USA.,Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Dermatology and Medicine, Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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33
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Chong BF, Werth V. Cutaneous Lupus Erythematosus and Dermatomyositis: Utilizing Assessment Tools for Treatment Efficacy. J Invest Dermatol 2021; 142:936-943. [PMID: 34952717 DOI: 10.1016/j.jid.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/06/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022]
Abstract
There have been important developments in defining cutaneous lupus erythematosus and dermatomyositis. The skin manifestations of these two diseases have a profound impact on QOL, with both emotional and symptomatic impacts that are important to address. The proliferation of potential therapeutic targets has made it important to make sure that these diseases are defined in a way that they can be included in translational and clinical studies of both localized and systemic forms of the diseases. There are now validated disease tools and QOL studies that are facilitating current and future scientific and therapeutic developments.
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Affiliation(s)
- Benjamin F Chong
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Victoria Werth
- Department of Dermatology, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
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34
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Chi S, Xue J, Chen X, Liu X, Ji Y. Correlation of plasma and urine Wnt5A with the disease activity and cutaneous lesion severity in patients with systemic lupus erythematosus. Immunol Res 2021; 70:174-184. [PMID: 34860323 PMCID: PMC8917110 DOI: 10.1007/s12026-021-09253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
Reliable noninvasive biomarkers are needed to accurately assess disease activity and prognosis in patients with systemic lupus erythematosus (SLE). The purpose of this study was to investigate the clinical relevance of Wnt5A with disease activity and severity with cutaneous involvement in particular in SLE patients; its concentrations in plasma and urine were examined and analyzed. In the cross-sectional study, the clinical relevance of Wnt5A protein was evaluated in both plasma and urine of SLE patients and healthy cohorts using commercial enzyme-linked immunosorbent assays (ELISA). Significantly, more abundances of Wnt5A protein were determined in both of plasmas and urines of SLE patients compared to healthy cohorts (p < 0.0001), which were even higher in active disease (AD) SLE patients relative to low disease activity (LDA) SLE patients (p < 0.0001). Meanwhile, the ROC curve analysis demonstrated that the plasma and urine Wnt5A were potential candidate biomarkers for identifying the disease activity and severity in SLE patients. The discriminant function analysis further revealed that the plasma and urine Wnt5A were separated and distinct for AD SLE patients and healthy controls. In consistence, the disease severity was correlated with the plasma and urine Wnt5A as ascertained by CLASI activity score and the prevalence of serositis in SLE patients. These results suggest that Wnt5A, as a summary measure for different inflammatory processes, could be a potential biomarker for accessing the disease activity, and a noninvasive biomarker for evaluating the disease severity in terms of cutaneous involvement in SLE patients.
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Affiliation(s)
- Shuhong Chi
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, 710061, Shanxi, China.,Department of Rheumatology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Jing Xue
- Human Stem Cell Institute, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Xiaodong Chen
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, 710061, Shanxi, China
| | - Xiaoming Liu
- Department of Anatomy and Cell Biology, Carver College of Medicine, The University of Iowa, 51 Newton Road, Iowa City, IA, 52242, USA.
| | - Yanhong Ji
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Centre, No. 76 Yanta West Road, Xi'an, 710061, Shanxi, China.
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35
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Calugareanu A, Grolleau C, Le Buanec H, Chasset F, Jachiet M, Battistella M, Bagot M, Jullien D, Poutrel S, Bouaziz JD, Ben Said B. Clinical efficacy of selective JAK1 inhibition and transcriptome analysis of chronic discoid lupus erythematosus. J Eur Acad Dermatol Venereol 2021; 36:e308-e310. [PMID: 34839559 DOI: 10.1111/jdv.17839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/24/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022]
Affiliation(s)
- A Calugareanu
- Severe Cutaneous Adverse Reaction (SCAR) Regional Center and Dermatology Department, CHU Lyon Centre, Hospices Civils de Lyon (HCL), Lyon, France.,INSERM U976, Hôpital Saint-Louis, Paris, France
| | - C Grolleau
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - H Le Buanec
- INSERM U976, Hôpital Saint-Louis, Paris, France
| | - F Chasset
- Dermatology Department, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - M Jachiet
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - M Battistella
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Pathology Department, AP-HP, Hôpital Saint-Louis, Paris, France
| | - M Bagot
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - D Jullien
- Severe Cutaneous Adverse Reaction (SCAR) Regional Center and Dermatology Department, CHU Lyon Centre, Hospices Civils de Lyon (HCL), Lyon, France
| | - S Poutrel
- Internal Medicine Department, CHU Lyon Centre, Hospices civils de Lyon (HCL), Lyon, France
| | - J-D Bouaziz
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - B Ben Said
- Severe Cutaneous Adverse Reaction (SCAR) Regional Center and Dermatology Department, CHU Lyon Centre, Hospices Civils de Lyon (HCL), Lyon, France
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36
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Connelly K, Morand EF. Filgotinib in cutaneous lupus: is a negative positive? Rheumatology (Oxford) 2021; 61:2213-2214. [PMID: 34791095 DOI: 10.1093/rheumatology/keab856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kathryn Connelly
- Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia
| | - Eric F Morand
- Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia
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37
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Joos L, Vetterli F, Jaeger T, Cozzio A, von Kempis J, Rubbert-Roth A. Treatment of refractory subacute cuataneous lupus erythematosus with baricitinib. Clin Exp Dermatol 2021; 47:748-750. [PMID: 34747511 DOI: 10.1111/ced.15005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 01/14/2023]
Abstract
We report on a patient who presented with refractory subacute cutaneous lupus erythematosus. The scaly annular and polycyclic patches/plaques, and hyperkeratotic lesions on multiple fingers improved rapidly after treatment with baricitinib.
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Affiliation(s)
- L Joos
- Division of Rheumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - F Vetterli
- Division of Rheumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - T Jaeger
- PATHOdiagnostics, St Gallen, Switzerland
| | - A Cozzio
- Department of Dermatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - J von Kempis
- Division of Rheumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - A Rubbert-Roth
- Division of Rheumatology, Kantonsspital St Gallen, St Gallen, Switzerland
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38
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Connelly K, Vettivel J, Golder V, Kandane-Rathnayake R, Morand EF. Measurement of specific organ domains in lupus randomised controlled trials: a scoping review. Rheumatology (Oxford) 2021; 61:1341-1353. [PMID: 34664636 DOI: 10.1093/rheumatology/keab777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Randomised controlled trials (RCTs) in systemic lupus erythematosus (SLE, lupus) typically adopt composite responder definitions as primary efficacy endpoints, however outcomes within individual organ domains are also important to understand. The aim of this scoping review was to evaluate how organ-specific disease activity and therapeutic responses have been measured and reported in lupus RCTs. METHODS We searched MEDLINE, EMBASE, Cochrane registry and clinicaltrials.gov. Eligible studies were RCTs investigating efficacy of an immune-directed drug therapy in active SLE, published January 2000-March 2021, excluding studies limited to lupus nephritis. Data were extracted independently in duplicate into a template and summarised descriptively. RESULTS Thirty-four RCTs were included, of which 32 (94%) reported activity and/or responses in at least one organ domain. Study populations had a high, although variable, frequency of baseline musculoskeletal and mucocutaneous activity and low but also variable representation of other domains. Definitions of organ-specific responses were inconsistent, even within individual instruments. Response in most organ domains were evaluated using BILAG and SLEDAI components but meaningful comparison between treatment arms was limited by small subgroups analysed in a post hoc fashion. Specific mucocutaneous and arthritis instruments were also used, including within pre-specified organ-specific endpoints, which discriminated between treatment arms in some studies. CONCLUSION Mucocutaneous and musculoskeletal manifestations predominate in SLE RCTs. Organ-specific outcome measures are commonly reported, but definitions of involvement and response are inconsistent. Research into the development of new outcome measures for key organ domains, and validation and comparison of response definitions using existing instruments, is needed.
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Affiliation(s)
- Kathryn Connelly
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.,Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
| | - Jeevan Vettivel
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
| | - Vera Golder
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.,Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
| | | | - Eric F Morand
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.,Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
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Werth VP, Fleischmann R, Robern M, Touma Z, Tiamiyu I, Gurtovaya O, Pechonkina A, Mozaffarian A, Downie B, Matzkies F, Wallace D. Filgotinib or Lanraplenib in Moderate to Severe Cutaneous Lupus Erythematosus: A Phase 2, Randomised, Double-Blind, Placebo-Controlled Study. Rheumatology (Oxford) 2021; 61:2413-2423. [PMID: 34498056 PMCID: PMC9157055 DOI: 10.1093/rheumatology/keab685] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To explore the safety and efficacy of filgotinib (FIL), a Janus kinase 1 inhibitor, and lanraplenib (LANRA), a spleen kinase inhibitor in cutaneous lupus erythematosus (CLE). METHODS This was a phase 2, randomised, double-blind, placebo-controlled, exploratory, proof-of-concept study of LANRA (30 mg), FIL (200 mg), or placebo (PBO) once daily for 12 weeks in patients with active CLE. At week 12, PBO patients were rerandomised 1:1 to receive LANRA or FIL for up to 36 additional weeks. RESULTS Of 47 randomised patients, 45 were treated (N = 9 PBO, N = 19 LANRA, N = 17 FIL). The primary end point (change from baseline in Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity [CLASI-A] score at week 12) was not met. Least squares mean (standard error) CLASI-A score change from baseline was -5.5 (2.56) with PBO, -4.5 (1.91) with LANRA, and -8.7 (1.85) with FIL. Numerical differences between FIL and PBO were greater in select subgroups. A ≥ 5-point improvement in CLASI-A score at week 12 was achieved by 50.0%, 56.3%, and 68.8% in the PBO, LANRA, and FIL arms, respectively. A numerically greater proportion of patients in the FIL arm (50%) also achieved ≥50% improvement in CLASI-A score at week 12 (37.5% PBO, 31.3% LANRA). Most adverse events (AEs) were mild or moderate in severity. Two serious AEs were reported with LANRA and 1 with FIL. CONCLUSION The primary end point was not met. Select subgroups displayed a numerically greater treatment response to FIL relative to PBO. LANRA and FIL were generally well tolerated. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03134222.
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Affiliation(s)
- Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania; Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - Roy Fleischmann
- Metroplex Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael Robern
- Dermatology Ottawa Research Center, Ottawa, Ontario, Canada
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Daniel Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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40
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Karnell JL, Wu Y, Mittereder N, Smith MA, Gunsior M, Yan L, Casey KA, Henault J, Riggs JM, Nicholson SM, Sanjuan MA, Vousden KA, Werth VP, Drappa J, Illei GG, Rees WA, Ratchford JN. Depleting plasmacytoid dendritic cells reduces local type I interferon responses and disease activity in patients with cutaneous lupus. Sci Transl Med 2021; 13:13/595/eabf8442. [PMID: 34039741 DOI: 10.1126/scitranslmed.abf8442] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/12/2021] [Indexed: 12/22/2022]
Abstract
Plasmacytoid dendritic cells (pDCs) not only are specialized in their capacity to secrete large amounts of type I interferon (IFN) but also serve to enable both innate and adaptive immune responses through expression of additional proinflammatory cytokines, chemokines, and costimulatory molecules. Persistent activation of pDCs has been demonstrated in a number of autoimmune diseases. To evaluate the potential benefit of depleting pDCs in autoimmunity, a monoclonal antibody targeting the pDC-specific marker immunoglobulin-like transcript 7 was generated. This antibody, known as VIB7734, which was engineered for enhanced effector function, mediated rapid and potent depletion of pDCs through antibody-dependent cellular cytotoxicity. In cynomolgus monkeys, treatment with VIB7734 reduced pDCs in blood below the lower limit of normal by day 1 after the first dose. In two phase 1 studies in patients with autoimmune diseases, VIB7734 demonstrated an acceptable safety profile, comparable to that of placebo. In individuals with cutaneous lupus, VIB7734 profoundly reduced both circulating and tissue-resident pDCs, with a 97.6% median reduction in skin pDCs at study day 85 in VIB7734-treated participants. Reductions in pDCs in the skin correlated with a decrease in local type I IFN activity as well as improvements in clinical disease activity. Biomarker analysis suggests that responsiveness to pDC depletion therapy may be greater among individuals with high baseline type I IFN activity, supporting a central role for pDCs in type I IFN production in autoimmunity and further development of VIB7734 in IFN-associated diseases.
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Affiliation(s)
| | | | | | | | | | - Li Yan
- Viela Bio, Gaithersburg, MD 20878, USA
| | | | | | | | | | | | | | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, USA
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41
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Chasset F, Dayer JM, Chizzolini C. Type I Interferons in Systemic Autoimmune Diseases: Distinguishing Between Afferent and Efferent Functions for Precision Medicine and Individualized Treatment. Front Pharmacol 2021; 12:633821. [PMID: 33986670 PMCID: PMC8112244 DOI: 10.3389/fphar.2021.633821] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 12/19/2022] Open
Abstract
A sustained increase in type I interferon (IFN-I) may accompany clinical manifestations and disease activity in systemic autoimmune diseases (SADs). Despite the very frequent presence of IFN-I in SADs, clinical manifestations are extremely varied between and within SADs. The present short review will address the following key questions associated with high IFN-I in SADs in the perspective of precision medicine. 1) What are the mechanisms leading to high IFN-I? 2) What are the predisposing conditions favoring high IFN-I production? 3) What is the role of IFN-I in the development of distinct clinical manifestations within SADs? 4) Would therapeutic strategies targeting IFN-I be helpful in controlling or even preventing SADs? In answering these questions, we will underlie areas of incertitude and the intertwined role of autoantibodies, immune complexes, and neutrophils.
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Affiliation(s)
- François Chasset
- Department of Dermatology and Allergology, Faculty of Medicine, AP-HP, Tenon Hospital, Sorbonne University, Paris, France
| | - Jean-Michel Dayer
- Emeritus Professor of Medicine, School of Medicine, Geneva University, Geneva, Switzerland
| | - Carlo Chizzolini
- Department of Pathology and Immunology, School of Medicine, Geneva University, Geneva, Switzerland
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42
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Chatham WW, Furie R, Saxena A, Brohawn P, Schwetje E, Abreu G, Tummala R. Long-Term Safety and Efficacy of Anifrolumab in Adults With Systemic Lupus Erythematosus: Results of a Phase II Open-Label Extension Study. Arthritis Rheumatol 2021; 73:816-825. [PMID: 33225631 PMCID: PMC8252065 DOI: 10.1002/art.41598] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/17/2020] [Indexed: 12/27/2022]
Abstract
Objective To investigate long‐term safety and tolerability of anifrolumab, a human monoclonal antibody to the type I interferon (IFN) receptor subunit 1, in patients with moderate‐to‐severe systemic lupus erythematosus (SLE). Methods This 3‐year, multinational, open‐label extension study included adult patients who completed treatment (48 weeks of anifrolumab or placebo; 12‐week follow‐up) in the MUSE phase IIb randomized controlled trial (RCT). Patients initially received 1,000 mg of anifrolumab intravenously every 4 weeks, which was reduced to 300 mg every 4 weeks based on the benefit/risk profile established in the MUSE trial. Adverse events (AEs) were assessed monthly. Exploratory end points included the SLE Disease Activity Index 2000 (SLEDAI‐2K), Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), pharmacodynamics, and health‐related quality of life (HRQoL). Results Of the 246 patients who completed the RCT, 218 (88.6%) enrolled in the open‐label extension study, of which 139 (63.8%) completed 3 years of treatment. Approximately 69.7% of patients reported ≥1 AE during the first year of open‐label extension treatment. Frequency and patterns of serious AEs and AEs of special interest over 3 years were consistent with those reported for 1 year of treatment in the RCT. Few patients (6.9%) discontinued treatment due to AEs. No new safety signals were identified. Improvement in the SLEDAI‐2K was sustained over 3 years. SDI and Short Form 36 health survey scores remained stable. Neutralization of type I IFN gene signatures was maintained in the IFN‐high population, and C3, C4, and anti–double‐stranded DNA showed trends toward sustained improvement. Conclusion Long‐term anifrolumab treatment demonstrates an acceptable safety profile with sustained improvement in SLE disease activity, HRQoL, and serologic measures.
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43
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Merola JF, Wang W, Wager CG, Hamann S, Zhang X, Thai A, Roberts C, Lam C, Musselli C, Marsh G, Rabah D, Barbey C, Franchimont N, Reynolds TL. RNA tape sampling in cutaneous lupus erythematosus discriminates affected from unaffected and healthy volunteer skin. Lupus Sci Med 2021; 8:8/1/e000428. [PMID: 33658303 PMCID: PMC7931768 DOI: 10.1136/lupus-2020-000428] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/20/2020] [Accepted: 01/17/2021] [Indexed: 12/13/2022]
Abstract
Objective Punch biopsy, a standard diagnostic procedure for patients with cutaneous lupus erythematosus (CLE) carries an infection risk, is invasive, uncomfortable and potentially scarring, and impedes patient recruitment in clinical trials. Non-invasive tape sampling is an alternative that could enable serial evaluation of specific lesions. This cross-sectional pilot research study evaluated the use of a non-invasive adhesive tape device to collect messenger RNA (mRNA) from the skin surface of participants with CLE and healthy volunteers (HVs) and investigated its feasibility to detect biologically meaningful differences between samples collected from participants with CLE and samples from HVs. Methods Affected and unaffected skin tape samples and simultaneous punch biopsies were collected from 10 participants with CLE. Unaffected skin tape and punch biopsies were collected from 10 HVs. Paired samples were tested using quantitative PCR for a candidate immune gene panel and semi-quantitative immunohistochemistry for hallmark CLE proteins. Results mRNA collected using the tape device was of sufficient quality for amplification of 94 candidate immune genes. Among these, we found an interferon (IFN)-dominant gene cluster that differentiated CLE-affected from HV (23-fold change; p<0.001) and CLE-unaffected skin (sevenfold change; p=0.002), respectively. We found a CLE-associated gene cluster that differentiated CLE-affected from HV (fourfold change; p=0.005) and CLE-unaffected skin (fourfold change; p=0.012), respectively. Spearman’s correlation between per cent area myxovirus 1 protein immunoreactivity and IFN-dominant mRNA gene cluster expression was highly significant (dermis, rho=0.86, p<0.001). In total, skin tape-derived RNA expression comprising both IFN-dominant and CLE-associated gene clusters correlated with per cent area immunoreactivity of some hallmark CLE-associated proteins in punch biopsies from the same lesions. Conclusions A non-invasive tape RNA collection technique is a potential tool for repeated skin biomarker measures throughout a clinical trial.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Alice Thai
- Biogen Inc, Cambridge, Massachusetts, USA
| | | | - Christina Lam
- Dermatology, Boston University, Boston, Massachusetts, USA
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44
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Chakka S, Krain RL, Concha JSS, Chong BF, Merola JF, Werth VP. The CLASI, a validated tool for the evaluation of skin disease in lupus erythematosus: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:431. [PMID: 33842652 PMCID: PMC8033342 DOI: 10.21037/atm-20-5048] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cutaneous lupus erythematosus (CLE) can present with or without features of systemic lupus erythematosus (SLE), with estimates of the incidence of isolated skin disease almost equaling the incidence of those with systemic disease. However, despite the impact CLE has on a patient’s quality of life (QoL), there has been no US Food and Drug Administration (FDA) approved treatment for the disease in the past 50 years. In addition, patients with skin predominant LE are often excluded from clinical SLE trials. In the rare trials that include patients with skin predominant LE, disease activity and progression in the skin are often difficult to evaluate using multi-organ outcome measures. The need for new therapies for CLE and the lack of focus on skin outcomes has led to the development of the Cutaneous Lupus Disease Area and Severity Index (CLASI), a validated organ-specific outcome measure that is not only responsive to change in disease activity and damage but also correlated to changes in a patient’s QoL. This paper will emphasize the extensive validation studies performed in developing the CLASI, as well as the importance of clinical trials using the CLASI to address the need for improved therapies for patients with lupus skin manifestations.
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Affiliation(s)
- Srita Chakka
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca L Krain
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Josef Symon S Concha
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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45
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Rogers CL, Gibson M, Kern JS, Martin LK, Robertson SJ, Daniel BS, Su JC, Murrell OGC, Feng G, Murrell DF. A comparison study of outcome measures for epidermolysis bullosa: Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) and the Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (iscorEB). JAAD Int 2021; 2:134-152. [PMID: 34409361 PMCID: PMC8362226 DOI: 10.1016/j.jdin.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 12/19/2022] Open
Abstract
Background The success of clinical trials in Epidermolysis Bullosa (EB) is dependent upon the availability of a valid and reliable scoring tool that can accurately assess and monitor disease severity. The Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) and Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (iscorEB) were independently developed and validated against the Birmingham Epidermolysis Bullosa Severity Score but have never been directly compared. Objective To compare the reliability, convergent validity, and discriminant validity of the EBDASI and iscorEB scoring tools. Methods An observational cohort study was conducted in 15 patients with EB. Each patient was evaluated using the EBDASI and iscorEB-clinician scoring tools by 6 dermatologists with expertise in EB. Quality of life was assessed using the iscorEB-patient and Quality of Life in EB measures. Results The intraclass correlation coefficients for interrater reliability were 0.942 for the EBDASI and 0.852 for the iscorEB-clinician. The intraclass correlation coefficients for intrarater reliability was 0.99 for both scores. The two tools demonstrated strong convergent validity with each other. Conclusion Both scoring tools demonstrate excellent reliability. The EBDASI appears to better discriminate between EB types and disease severities.
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Key Words
- BEBS, Birmingham Epidermolysis Bullosa Severity Score
- BMD, bone mineral densitometry
- DDEB, dominant dystrophic epidermolysis bullosa
- EB, epidermolysis bullosa
- EBDASI, Epidermolysis Bullosa Disease Activity and Scarring Index
- EBS, epidermolysis bullosa simplex
- Epidermolysis Bullosa Disease Activity and Scarring Index
- ICC, intraclass correlation coefficient
- Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa
- JEB, junctional epidermolysis bullosa
- QOLEB, Quality of Life in Epidermolysis Bullosa score
- QoL, quality of life
- RDEB, recessive dystrophic epidermolysis bullosa
- blistering skin disease
- dermatology
- epidermolysis bullosa
- iscorEB, Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa
- outcome measure
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Affiliation(s)
- Clare L Rogers
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia.,Premier Specialists, Dermatology Trials Australia, Kogarah, New South Wales, Australia
| | - Matthew Gibson
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia.,Premier Specialists, Dermatology Trials Australia, Kogarah, New South Wales, Australia
| | - Johannes S Kern
- Department of Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda K Martin
- Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Susan J Robertson
- Department of Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Dermatology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Dermatology, Monash Health, Melbourne, Victoria, Australia
| | - Benjamin S Daniel
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
| | - John C Su
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Dermatology, Monash Health, Melbourne, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Oliver G C Murrell
- Premier Specialists, Dermatology Trials Australia, Kogarah, New South Wales, Australia
| | - Grant Feng
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dedee F Murrell
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia.,Premier Specialists, Dermatology Trials Australia, Kogarah, New South Wales, Australia
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46
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Salle R, Chasset F, Kottler D, Picard-Dahan C, Jannic A, Mekki N, De Risi-Pugliese T, Monfort JB, Barbaud A, Francès C, Descamps V. Belimumab for refractory manifestations of cutaneous lupus: A multicenter, retrospective observational study of 16 patients. J Am Acad Dermatol 2020; 83:1816-1819. [DOI: 10.1016/j.jaad.2020.05.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/16/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
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47
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Arora S, Isenberg DA, Castrejon I. Measures of Adult Systemic Lupus Erythematosus: Disease Activity and Damage. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:27-46. [PMID: 33091256 DOI: 10.1002/acr.24221] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/09/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Shilpa Arora
- Rush University Medical Center, Chicago, Illinois
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48
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Janus Kinase Inhibition and SLE: Is this a Plausible Treatment Option for SLE? CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00155-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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49
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Rosina S, Tibaldi J, Mazzoni M, Bava C, Natoli V, Ravelli A. Update on Outcome Measures for Pediatric Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:163-170. [PMID: 33091272 DOI: 10.1002/acr.24212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jessica Tibaldi
- IRCCS Istituto Giannina Gaslini and Università degli Studi di Genova, Genoa, Italy
| | | | | | | | - Angelo Ravelli
- Sechenov First Moscow State Medical University, Moscow, Russia
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50
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Mack E, Exton LS, Mohd Mustapa MF, McCourt C, O'Kane D. Use of the Cutaneous Lupus Disease Area and Severity Index as an outcome measure in clinical trials: a descriptive study. Clin Exp Dermatol 2020; 46:147-152. [PMID: 32790078 DOI: 10.1111/ced.14420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2020] [Indexed: 11/29/2022]
Abstract
This study summarizes the use, since its inception, of the Cutaneous Lupus Disease Area and Severity Index (CLASI) as an outcome measure in clinical studies. We systematically searched the MEDLINE, PubMed, EMBASE and Cochrane databases for papers including the term 'cutaneous lupus disease area and severity index' and its abbreviations up to August 2017, identifying 205 abstracts. Following shortlisting, two independent physicians critically reviewed 71 papers for data extraction. We found that a limited number of high-quality studies used the CLASI scoring as an outcome measure. We concluded that further validation is necessary to identify the effectiveness of the CLASI in the assessment of cutaneous lupus erythematosus subtypes. The use of standardized core patient- and physician-reported outcome measures may reduce heterogeneity and allow comparisons between patients enrolled in clinical trials. This would improve the relevance within clinical practice, where the use of CLASI is currently limited.
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Affiliation(s)
- E Mack
- Deparment of Dermatology, Belfast Health and Social Care Trust, Belfast, UK
| | - L S Exton
- Willan House, British Association of Dermatologists, London, UK
| | | | - C McCourt
- Deparment of Dermatology, Belfast Health and Social Care Trust, Belfast, UK
| | - D O'Kane
- Deparment of Dermatology, Belfast Health and Social Care Trust, Belfast, UK
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