Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Rapid Response of Refractory Systemic Lupus Erythematosus Skin Manifestations to Anifrolumab – A Case-Based Review of Clinical Trial Data Suggesting A Domain-Based Therapeutic Approach

Version 1 : Received: 9 May 2022 / Approved: 10 May 2022 / Online: 10 May 2022 (07:45:29 CEST)

How to cite: Plüß, M.; Piantoni, S.; Wincup, C.; Korsten, P. Rapid Response of Refractory Systemic Lupus Erythematosus Skin Manifestations to Anifrolumab – A Case-Based Review of Clinical Trial Data Suggesting A Domain-Based Therapeutic Approach. Preprints 2022, 2022050128 (doi: 10.20944/preprints202205.0128.v1). Plüß, M.; Piantoni, S.; Wincup, C.; Korsten, P. Rapid Response of Refractory Systemic Lupus Erythematosus Skin Manifestations to Anifrolumab – A Case-Based Review of Clinical Trial Data Suggesting A Domain-Based Therapeutic Approach. Preprints 2022, 2022050128 (doi: 10.20944/preprints202205.0128.v1).

Abstract

Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease, and organ manifestations, such as lupus nephritis (LN) or skin disease, may be refractory to standard treatment. Therefore, new agents are required to allow for a more personalized therapeutic approach. Recently, several new therapies have been approved internationally, including voclosporine for LN and anifrolumab for moderately to severely active SLE. Here, we report a case of SLE with a predominant and refractory cutaneous manifestation despite treatment with glucocorticoids, hydroxychloroquine, mycophenolate mofetil, and belimumab. Belimumab was switched to anifrolumab, and the patient responded quickly after two infusions (eight weeks) with a reduction of the Cutaneous Lupus Assessment and Severity Index (CLASI) from 17 to 7. In addition, we review the available clinical trial data for anifrolumab with a focus on cutaneous outcomes. Based on phase II and III clinical trials investigating the intravenous administration, a consistent CLASI improvement was observed at 12 weeks. Interestingly, in a phase II trial of subcutaneous anifrolumab application, CLASI response was not different from placebo at 12 weeks but numerically different at 24 and 52 weeks, respectively. Thus, anifrolumab emerges as an attractive new therapeutic option suggesting a possible domain-based approach.

Keywords

systemic lupus erythematosus; anifrolumab; interferon; cutaneous lupus erythematosus

Subject

MEDICINE & PHARMACOLOGY, Other

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