Reply to: S2k guideline for treatment of cutaneous lupus erythematosus-guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV)

Anifrolumab for Treatment of Refractory Cutaneous Lupus Erythematosus

Cutaneous lupus erythematosus (CLE) is a spectrum of skin changes related to systemic lupus erythematosus (SLE), a family of autoimmunity manifesting characteristic multisystem inflammation and damage. Treatment of CLE continues to evolve, especially for patients with moderate to severe disease. Type 1 interferon (IFN-1) play a significant role in CLE. IFN-1 binds to interferon α receptor 1 (IFNAR1) resulting in a cascade of immunological events that contribute to CLE pathogenesis. Anifrolumab, a fully humanized monoclonal antibody that selectively binds IFNAR1, prevents the formation of the IFN-1/IFNAR1 complex and subsequent gene transcription. Multiple phase 2 and 3 randomized trials have resulted in federal drug administration approval for anifrolumab in the treatment of moderate to severe SLE. We present a case series of patients whose refractory cutaneous lupus significantly improved with anifrolumab.

Current Insights Into The Management Of Discoid Lupus Erythematosus

Discoid lupus erythematosus is the most disfiguring and common presentation of chronic cutaneous lupus erythematosus. Although most patients will respond to lifestyle measures and topical treatment, a non-negligible number of patients will require systemic and physical therapy, either alone or in combination. We performed a review of the available evidence on the discoid lupus erythematosus treatment. Lifestyle measures and topical treatment (corticosteroids and topical calcineurin inhibitors) remain the therapeutic strategies with the highest evidence level. Within systemic treatment approaches, antimalarial drugs are still the first-line therapy, while other systemic and physical therapies have highly variable evidence. Hence, we propose a therapeutic algorithm based on the strength of recommendations of the different treatment modalities, focusing on the refractory disease.