Novel biological therapeutic approaches to cutaneous lupus erythematosus

ABSTRACT

Introduction: Cutaneous lupus erythematosus (CLE) encompasses a spectrum of dermatologic manifestations which can occur with or without systemic lupus erythematosus (SLE). Treatment of CLE is challenging as the traditional treatments are off label and often fail and there is no drug specifically approved for CLE. The knowledge gained from the emerging trials on biologic therapy in SLE has provided insight into the utility of biologic therapy for CLE.

Areas covered: An overview is provided on the biological agents studied for CLE discussing their immunological target, their efficacy in treating the various CLE manifestations and the outcome measures used.

Expert opinion: There is a paucity of trials dedicated to the biologic treatment of CLE. Several of the described biological treatments’ efficacy suggests that different clinical phenotypes of CLE may require different immunological targeted therapies. Recently published and ongoing trials of SLE focusing on novel agents for CLE using the Cutaneous Lupus Area and Severity Index (CLASI) as the outcome measure have shown promising results. Further trials designed specifically to study the efficacy of biologic treatment in CLE subgroups with or without systemic involvement using specific metrics for assessing cutaneous involvement are needed and will aid in illuminating the role of biologic therapy in CLE.

KEYWORDS:

• Lupus
• biologics
• skin
• cutaneous

Article highlights

• The treatment of CLE can be very challenging due to variance in expression and paucity of trials dedicated to treatment of CLE, hence it is frequently based on personal expertise and experience.

• There are several different biologic drugs that can be used to treat CLE based on case series and observational studies which differ in their immunological targets; however, currently the only approved biologic drug for SLE is belimumab, and there is no biologic drug approved for CLE.

• Belimumab is efficacious in the treatment of SLE and post-hoc analyses from trials as well as real-life experience showed positive results for the treatment of CLE.

• The significant role suggested for type I IFNs in CLE along with the primary encouraging results from phase I and II drug trials of different anti-IFN agents, suggest sifalimumab and anifrolumab as very promising agents for CLE treatment.

• The Cutaneous Lupus Area and Severity Index (CLASI) is a valid and responsive tool to measure cutaneous disease activity and damage in clinical trials and practice.

This box summarizes key points contained in the article.

Declaration of interest

Z Touma holds a Young Investigator Salary Award provided by The Arthritis Society and the Physicians’ Services Incorporated Foundation. The University of Toronto Lupus Clinic is supported Lupus Foundation of Ontario and the Lou Rocca Family. Z Touma has consulted for GlaxoSmithKline, Merck Serono and Janssen Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This article was not funded.