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Anifrolumab treatment in adolescents with recalcitrant discoid lupus erythematosus: a case series
Context
Anifrolumab has emerged as a promising treatment option for refractory discoid lupus erythematosus (DLE), following its 2021 approval for adults with systemic lupus erythematosus (SLE). However, its effectiveness in treating adolescents with SLE and recalcitrant DLE is unclear. Here, we summarize a case series published by Shaw et al.1 in JAMA Network Open on the effectiveness and safety of anifrolumab in recalcitrant adolescents with DLE.
Methods
This multicenter, retrospective case series included adolescents with SLE and recalcitrant DLE treated between August 1, 2022, and June 30, 2023. The primary outcome was reduction in Cutaneous Lupus Erythematosus Disease Area and Severity Index score (CLASI)-Activity (CLASI-A) score and CLASI-Damage (CLASI-D).
Key findings
The case series included seven adolescents with DLE with a median age of 17 years (range, 14–20 years), treated intravenously with 300 mg anifrolumab every 4 weeks. Four patients were Asian, two were Black/African American, and one patient was White. The baseline characteristics are presented in Figure 1.
Figure 1. Baseline characteristics, current treatment regimen, and outcomes*
AZA, azathioprine, BEL, belimumab; HCQ, hydroxychloroquine; CLASI-A, Cutaneous Lupus Erythematosus Disease Area and Severity Index–Activity; CLASI-D, CLASI–Damage; IVIG, intravenous immunoglobulin; ILS, intralesional corticosteroids; MMF, mycophenolate mofetil; MTX, methotrexate; RTX, rituximab; SLEDAI-2K, Systemic Lupus Erythematosus Disease Activity Index 2000; SCS, systemic corticosteroid.
*Data from Shaw, et al.1
A substantial improvement in cutaneous disease activity was observed in all patients initiating anifrolumab. Within a month of initiation, a 72.1% mean decrease in CLASI-A score was reported (p = 0.01); this sustained at 6-month follow-up. There was an improvement in overall disease activity, measured by SLE Disease Activity Index 2000 score, with a mean decrease of 7.0 at the last follow-up. The CLASI-D scores calculated at Month 1 and 6 showed no significant differences compared with baseline.
Anifrolumab was well tolerated. One case of recurrent herpes simplex virus type 1 reactivation was reported, in line with the increased susceptibility to viral infections noted in clinical trials, as previously published on the Lupus Hub.
Key learnings
The findings indicate that anifrolumab induces rapid and persistent responses in adolescents with DLE for whom conventional therapies fail to yield a response. The study limitations include its retrospective design and relatively small patient population.
References
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