Original articleLenalidomide therapy in treatment-refractory cutaneous lupus erythematosus: Histologic and circulating leukocyte profile and potential risk of a systemic lupus flare
Section snippets
Patients
Five patients were enrolled according to the following inclusion criteria: (1) DLE or SCLE diagnosis, (2) no response to 3 months of hydroxychloroquine, and (3) participation in RevAssist, a distribution program run by the manufacturers of lenalidomide.26 Patients with SLE (by American College of Rheumatology criteria); who were pregnant; had thrombocytopenia, lymphopenia, or neutropenia; or a history of deep venous thrombosis or pulmonary embolism were excluded. Informed consent was obtained.
Results
We present the clinical response to lenalidomide in 5 subjects and describe the histologic features and circulating leukocyte profile before and after treatment. Expression levels of IFN-inducible genes in blood before and after treatment are shown as a measure of systemic IFN-mediated signaling.
Discussion
Four of 5 patients with treatment-refractory CLE had a clinically satisfactory response to lenalidomide. Two of the responders (subjects 1 and 3) and the nonresponder previously failed thalidomide therapy. Lesional biopsy specimens showed histologic features of CLE including CD3+ infiltrate and GAG accumulation. Two subjects had a CD4 predominant infiltrate, in keeping with prior reports.9, 10 Recent investigation suggests CD4 predominance better characterizes SCLE and TLE, whereas CD8
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Long-term efficacy and safety outcomes of lenalidomide for cutaneous lupus erythematosus: A multicenter retrospective observational study of 40 patients
2021, Journal of the American Academy of DermatologyUngual lesions in lupus erythematosus: A retrospective study of 14 patients
2020, Annales de Dermatologie et de VenereologieManagement of cutaneous manifestations of lupus erythematosus: A systematic review
2020, Seminars in Arthritis and RheumatismCitation Excerpt :Twenty-two studies in 629 patients looked at thalidomide or lenalidomide therapy in CLE [60–78,110–112] (Table 8). Fourteen studies looked at thalidomide therapy [60–73,112], and 5 investigated lenalidomide [74–78]. Seven studies were non-controlled trials [60–62,74–76,111], 7 observational studies [63–67,77,112] and 8 case series [68–73,78,110].
The treatment of systemic lupus erythematosus: Back to the future
2019, Revue du Rhumatisme (Edition Francaise)Should Generalized Immunosuppression or Targeted Organ Treatment be the Best Principle for Overall Management of Systemic Lupus Erythematosus?
2019, Rheumatic Disease Clinics of North AmericaCitation Excerpt :The potential use for this biologic in these types of Ro-positive patients is being investigated in ongoing clinical trials. T cells are present in lupus skin lesions, with an observed predominance of CD4 cells in some specific subtypes such as subacute cutaneous lupus erythematosus, while scarring conditions such as DLE show CD8 predominance.16 In DLE skin lesions, high levels of CD8 cytotoxic T cells may release intragranular molecules such as TIA-1, with damaging local effects.9
Supported in part by the Alliance for Lupus Research, a Merit Review Grant from the Department of Veterans Affairs Veterans Health Administration, Office of Research and Development, Biomedical Laboratory Research and Development, and by the National Institutes of Health (K24-AR 02207) to Dr Werth. Celgene Corporation provided the drug free of charge.
Conflicts of interest: None declared.