Hong Shi1, Johann E Gudjonsson2, J Michelle Kahlenberg1. 1. Division of Rheumatology, Department of Internal Medicine. 2. Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.
Abstract
PURPOSE OF REVIEW: Cutaneous lupus erythematosus (CLE) is a highly heterogeneous autoimmune disease. No specific Federal Drug Administration-approved therapies for CLE-alone are available, and resistance to conventional treatments is common. This review will summarize current treatment approaches and pending treatment strategies. RECENT FINDINGS: Research into the pathogenesis of CLE is accelerating. A skewed type I interferon production and response contribute to CLE lesions. The pathophysiology of lesions may be similar among the lesional subtypes, and patients with a more TLR9-driven disease mechanism may have more benefit from hydroxychloroquine. Case reports continue to support the use of dapsone for CLE, especially bullous lupus erythematosus. Rituximab and Belimumab have efficacy in patients with systemic lupus erythematosus and severe active CLE. The significant role for type I interferons in CLE and encouraging clinical data suggest anifrolumab as a very promising agent for CLE. Dapirolizumab, BIIB059, Ustekinumab and Janus kinase inhibitors also have supportive early data as promising new strategies for CLE treatment. SUMMARY: Continued research to understand the mechanisms driving CLE will facilitate the development and approval of new targets. The pipeline for new treatments is rich.
PURPOSE OF REVIEW: Cutaneous lupus erythematosus (CLE) is a highly heterogeneous autoimmune disease. No specific Federal Drug Administration-approved therapies for CLE-alone are available, and resistance to conventional treatments is common. This review will summarize current treatment approaches and pending treatment strategies. RECENT FINDINGS: Research into the pathogenesis of CLE is accelerating. A skewed type I interferon production and response contribute to CLE lesions. The pathophysiology of lesions may be similar among the lesional subtypes, and patients with a more TLR9-driven disease mechanism may have more benefit from hydroxychloroquine. Case reports continue to support the use of dapsone for CLE, especially bullous lupus erythematosus. Rituximab and Belimumab have efficacy in patients with systemic lupus erythematosus and severe active CLE. The significant role for type I interferons in CLE and encouraging clinical data suggest anifrolumab as a very promising agent for CLE. Dapirolizumab, BIIB059, Ustekinumab and Janus kinase inhibitors also have supportive early data as promising new strategies for CLE treatment. SUMMARY: Continued research to understand the mechanisms driving CLE will facilitate the development and approval of new targets. The pipeline for new treatments is rich.
Authors: Garrett S Dunlap; Allison C Billi; Xianying Xing; Feiyang Ma; Mitra P Maz; Lam C Tsoi; Rachael Wasikowski; Jeffrey B Hodgin; Johann E Gudjonsson; J Michelle Kahlenberg; Deepak A Rao Journal: JCI Insight Date: 2022-04-22
Authors: Alice Verdelli; Alberto Corrà; Elena Biancamaria Mariotti; Cristina Aimo; Valentina Ruffo di Calabria; Walter Volpi; Lavinia Quintarelli; Marzia Caproni Journal: Front Med (Lausanne) Date: 2022-09-23