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Werth VP, Furie RA, Romero-Diaz J, Navarra S, Kalunian K, van Vollenhoven RF, Nyberg F, Kaffenberger BH, Sheikh SZ, Radunovic G, Huang X, Clark G, Carroll H, Naik H, Gaudreault F, Meyers A, Barbey C, Musselli C, Franchimont N. Trial of Anti-BDCA2 Antibody Litifilimab for Cutaneous Lupus Erythematosus. N Engl J Med 2022; 387:321-331. [PMID: 35939578 DOI: 10.1056/nejmoa2118024] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Blood dendritic cell antigen 2 (BDCA2) is a receptor that is exclusively expressed on plasmacytoid dendritic cells, which are implicated in the pathogenesis of lupus erythematosus. Whether treatment with litifilimab, a humanized monoclonal antibody against BDCA2, would be efficacious in reducing disease activity in patients with cutaneous lupus erythematosus has not been extensively studied. METHODS In this phase 2 trial, we randomly assigned adults with histologically confirmed cutaneous lupus erythematosus with or without systemic manifestations in a 1:1:1:1 ratio to receive subcutaneous litifilimab (at a dose of 50, 150, or 450 mg) or placebo at weeks 0, 2, 4, 8, and 12. We used a dose-response model to assess whether there was a response across the four groups on the basis of the primary end point, which was the percent change from baseline to 16 weeks in the Cutaneous Lupus Erythematosus Disease Area and Severity Index-Activity score (CLASI-A; scores range from 0 to 70, with higher scores indicating more widespread or severe skin involvement). Safety was also assessed. RESULTS A total of 132 participants were enrolled; 26 were assigned to the 50-mg litifilimab group, 25 to the 150-mg litifilimab group, 48 to the 450-mg litifilimab group, and 33 to the placebo group. Mean CLASI-A scores for the groups at baseline were 15.2, 18.4, 16.5, and 16.5, respectively. The difference from placebo in the change from baseline in CLASI-A score at week 16 was -24.3 percentage points (95% confidence interval [CI] -43.7 to -4.9) in the 50-mg litifilimab group, -33.4 percentage points (95% CI, -52.7 to -14.1) in the 150-mg group, and -28.0 percentage points (95% CI, -44.6 to -11.4) in the 450-mg group. The least squares mean changes were used in the primary analysis of a best-fitting dose-response model across the three drug-dose levels and placebo, which showed a significant effect. Most of the secondary end points did not support the results of the primary analysis. Litifilimab was associated with three cases each of hypersensitivity and oral herpes infection and one case of herpes zoster infection. One case of herpes zoster meningitis occurred 4 months after the participant received the last dose of litifilimab. CONCLUSIONS In a phase 2 trial involving participants with cutaneous lupus erythematosus, treatment with litifilimab was superior to placebo with regard to a measure of skin disease activity over a period of 16 weeks. Larger and longer trials are needed to determine the effect and safety of litifilimab for the treatment of cutaneous lupus erythematosus. (Funded by Biogen; LILAC ClinicalTrials.gov number, NCT02847598.).
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MESH Headings
- Adult
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Dendritic Cells/drug effects
- Dendritic Cells/immunology
- Dose-Response Relationship, Drug
- Double-Blind Method
- Herpes Zoster/etiology
- Humans
- Lectins, C-Type/antagonists & inhibitors
- Lectins, C-Type/immunology
- Lupus Erythematosus, Cutaneous/drug therapy
- Membrane Glycoproteins/antagonists & inhibitors
- Membrane Glycoproteins/immunology
- Receptors, Immunologic/antagonists & inhibitors
- Receptors, Immunologic/immunology
- Severity of Illness Index
- Treatment Outcome
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Affiliation(s)
- Victoria P Werth
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Richard A Furie
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Juanita Romero-Diaz
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Sandra Navarra
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Kenneth Kalunian
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Ronald F van Vollenhoven
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Filippa Nyberg
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Benjamin H Kaffenberger
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Saira Z Sheikh
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Goran Radunovic
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Xiaobi Huang
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - George Clark
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Hua Carroll
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Himanshu Naik
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Francois Gaudreault
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Adam Meyers
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Catherine Barbey
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Cristina Musselli
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Nathalie Franchimont
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
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7
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Lu Q, Long H, Chow S, Hidayat S, Danarti R, Listiawan Y, Deng D, Guo Q, Fang H, Tao J, Zhao M, Xiang L, Che N, Li F, Zhao H, Lau CS, Ip FC, Ho KM, Paliza AC, Vicheth C, Godse K, Cho S, Seow CS, Miyachi Y, Khang TH, Ungpakorn R, Galadari H, Shah R, Yang K, Zhou Y, Selmi C, Sawalha AH, Zhang X, Chen Y, Lin CS. Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus. J Autoimmun 2021; 123:102707. [PMID: 34364171 DOI: 10.1016/j.jaut.2021.102707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/20/2022]
Abstract
Cutaneous lupus erythematosus (CLE) is an inflammatory, autoimmune disease encompassing a broad spectrum of subtypes including acute, subacute, chronic and intermittent CLE. Among these, chronic CLE can be further classified into several subclasses of lupus erythematosus (LE) such as discoid LE, verrucous LE, LE profundus, chilblain LE and Blaschko linear LE. To provide all dermatologists and rheumatologists with a practical guideline for the diagnosis, treatment and long-term management of CLE, this evidence- and consensus-based guideline was developed following the checklist established by the international Reporting Items for Practice Guidelines in Healthcare (RIGHT) Working Group and was registered at the International Practice Guideline Registry Platform. With the joint efforts of the Asian Dermatological Association (ADA), the Asian Academy of Dermatology and Venereology (AADV) and the Lupus Erythematosus Research Center of Chinese Society of Dermatology (CSD), a total of 25 dermatologists, 7 rheumatologists, one research scientist on lupus and 2 methodologists, from 16 countries/regions in Asia, America and Europe, participated in the development of this guideline. All recommendations were agreed on by at least 80% of the 32 voting physicians. As a consensus, diagnosis of CLE is mainly based on the evaluation of clinical and histopathological manifestations, with an exclusion of SLE by assessment of systemic involvement. For localized CLE lesions, topical corticosteroids and topical calcineurin inhibitors are first-line treatment. For widespread or severe CLE lesions and (or) cases resistant to topical treatment, systemic treatment including antimalarials and (or) short-term corticosteroids can be added. Notably, antimalarials are the first-line systemic treatment for all types of CLE, and can also be used in pregnant patients and pediatric patients. Second-line choices include thalidomide, retinoids, dapsone and MTX, whereas MMF is third-line treatment. Finally, pulsed-dye laser or surgery can be added as fourth-line treatment for localized, refractory lesions of CCLE in cosmetically unacceptable areas, whereas belimumab may be used as fourth-line treatment for widespread CLE lesions in patients with active SLE, or recurrence of ACLE during tapering of corticosteroids. As for management of the disease, patient education and a long-term follow-up are necessary. Disease activity, damage of skin and other organs, quality of life, comorbidities and possible adverse events are suggested to be assessed in every follow-up visit, when appropriate.
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Affiliation(s)
- Qianjin Lu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China.
| | - Hai Long
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, China.
| | | | - Syarief Hidayat
- League of ASEAN Dermatologic Societies, Kuala Lumpur, Malaysia
| | - Retno Danarti
- Department of Dermatology and Venereology, Gadjah Mada University, Yogyakarta, Indonesia
| | - Yulianto Listiawan
- Department of Dermatology and Venereology, Airlangga University, Surabaya, Indonesia
| | - Danqi Deng
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qing Guo
- Department of Dermatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Juan Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Zhao
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Leihong Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Nan Che
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fen Li
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongjun Zhao
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, China
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Fong Cheng Ip
- Department of Dermatology, Yung Fung Shee Dermatological Clinic, Hong Kong, China
| | - King Man Ho
- Social Hygiene Service, Department of Health, Hong Kong Government, Hong Kong, China
| | - Arnelfa C Paliza
- Department of Dermatology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | - Chan Vicheth
- Department of Dermatology, Khmer Soviet Friendship Hospital, Phnom Penh, Cambodia
| | - Kiran Godse
- D. Y. Patil University School of Medicine, Nerul, Navi Mumbai, India
| | - Soyun Cho
- Department of Dermatology, Seoul National University Boramae Medical Center, Seoul, South Korea
| | | | | | - Tran Hau Khang
- National Hospital of Dermatology, Vietnamese Society of Dermatology and Venereology, Hanoi, Viet Nam
| | - Rataporn Ungpakorn
- Skin and Aesthetic Lasers Clinic, Bumrungrad International Hospital, Bangkok, Thailand
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Amr H Sawalha
- Divisions of Rheumatology, Departments of Pediatrics and Medicine & Lupus Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xuan Zhang
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Chinese GRADE Center, Lanzhou University, Lanzhou, China.
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