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) plays a significant role in CLE pathogenesis.
Anifrolumab, a fully humanized
monoclonal antibody, selectively binds and inhibits the IFN-α receptor 1. Evidence from multiple Phase II and III randomized trials resulted in approval for
anifrolumab for treatment of moderate to severe SLE. We present a case series of three patients with refractory CLE significantly improved with
anifrolumab. The patients were recruited via clinic interaction and treated with
anifrolumab from January 2021 to April 2022. Each patient received at least 12 weeks of
therapy. Treatment and follow-up is ongoing. Patients were eligible for the study if they were a patient of the UNC Hospital System with resistant CLE, defined as having received inadequate disease control with standard
therapies, including
antimalarials, disease-modifying agents and biologics. Outcome measures were improvement in patient-reported symptoms and physician observation of
erythema and pigmentary changes. All cases demonstrated significant improvement in disease appearance, cutaneous involvement, and symptomology
after treatment with 2 months of
anifrolumab infusions.
Anifrolumab shows great potential for improving CLE in patients who have failed standard of care and multiple treatment options, including those that have failed
belimumab or those who
smoke. This report highlights the value of
anifrolumab in managing patients with refractory CLE.