Khan Muhammad Atif, Khan Faiza Humayun, Khan Hina Benish, Saadeh Constantine, Davey Nichole
Internal Medicine, University of Kansas Medical Center, Kansas City, USA.
Internal Medicine, Khyber Medical University, Peshawar, PAK.
Cureus. 2023 May 27;15(5):e39553. doi: 10.7759/cureus.39553. eCollection 2023 May.
Lupus erythematosus (LE) is an autoimmune disease that presents either as a systemic (SLE) or an isolated skin disease (CLE). Currently, there is no FDA-approved medication specifically for CLE, and is treated with the same approach as SLE. We present two refractory cases of SLE with severe cutaneous manifestations unresponsive to the first-line therapy treated with anifrolumab. First, a 39-year-old Caucasian female with a known history of SLE with severe subacute CLE presented to the clinic for her refractory cutaneous symptoms. Her current regimen was hydroxychloroquine (HCQ), mycophenolate mofetil (MMF), and s/c belimumab with no improvement. Belimumab was discontinued, and she was started on anifrolumab with significant improvement. Another, a 28-year-old female with no known medical history was referred to a rheumatology clinic for elevated anti-nuclear antibody (ANA) and ribonucleoprotein (RNP) titers. She was diagnosed with SLE, and was treated with HCQ, belimumab, and MMF but failed to produce a reasonably good outcome. Hence belimumab was discontinued and anifrolumab was added instead with significant cutaneous improvement. The treatment spectrum for SLE is wide, which includes antimalarial (HCQ), oral corticosteroids (OCS), and immunosuppressants (Methotrexate-MTX, MMF, azathioprine-AZT). Anifrolumab, a type 1 IFNα receptor subunit 1 (IFNAR1) inhibitor, has been recently approved by the FDA for moderate to severe SLE while on standard therapy in August 2021. Early use of anifrolumab in moderate to severe cutaneous manifestations of SLE or CLE may result in significant improvement in patients.
红斑狼疮（LE）是一种自身免疫性疾病，可表现为系统性红斑狼疮（SLE）或仅累及皮肤的疾病（CLE）。目前，美国食品药品监督管理局（FDA）尚未批准专门用于治疗CLE的药物，CLE的治疗方法与SLE相同。我们报告了两例难治性SLE病例，其严重皮肤表现对一线治疗无反应，后采用阿尼鲁单抗进行治疗。第一例，一名39岁的白种女性，有SLE病史，伴有严重的亚急性CLE，因难治性皮肤症状前来就诊。她目前的治疗方案是羟氯喹（HCQ）、霉酚酸酯（MMF）和皮下注射贝利尤单抗，但症状并无改善。停用贝利尤单抗后，开始使用阿尼鲁单抗，症状有显著改善。另一例，一名28岁、无已知病史的女性，因抗核抗体（ANA）和核糖核蛋白（RNP）滴度升高被转诊至风湿病诊所。她被诊断为SLE，接受了HCQ、贝利尤单抗和MMF治疗，但未取得理想效果。因此停用贝利尤单抗，改用阿尼鲁单抗，皮肤症状有显著改善。SLE的治疗范围广泛，包括抗疟药（HCQ）、口服糖皮质激素（OCS）和免疫抑制剂（甲氨蝶呤 - MTX、MMF、硫唑嘌呤 - AZT）。阿尼鲁单抗是一种1型干扰素α受体亚基1（IFNAR1）抑制剂，于2021年8月被FDA批准用于中度至重度SLE的标准治疗。在SLE或CLE的中度至重度皮肤表现中早期使用阿尼鲁单抗可能会使患者症状得到显著改善。
