Thalidomide Analogue Relieves Refractory Cutaneous Lupus


A small observational study shows lenalidomide effective against disfiguring cutaneous lupus resistant to other treatment. But the condition usually recurs after withdrawal.

Treatment with an offshoot of thalidomide-lenalidomide-can improve the response of patients living with the disfiguring form of lupus known as cutaneus lupus erythematosus (CLE) who don’t respond to medication, according to a small observational study reported in Arthritis Research and Therapy.

No treatments are approved for refractory CLE, there are no large trials to guide therapy and little consensus . About one-third of patients currently given traditional treatments for CLE-steroids, antimalarials, and immunosuppressive agents-show no significant benefit from their therapy. Relapse once the drug is withdrawn is fairly common.

Also, thalidomide also causes significant side effects. Its analogue lenalidomide (Revlimid) is less toxic. Introduced in 2004, it’s used in combination with dexamethasone to treat multiple myeloma.

The researchers from Vall d’Hebron University Hospital Research Institute in Spain conducted a Class II study in which 14 patients with CLE received 5 to 10 mg of oral lenalidomide daily over an average of 15 months. Results were defined by the CLASI score (Cutaneous Lupus Erythematosus Disease Area and Severity), with success being defined as seeing a complete response. Researchers also looked at side effects, cutaneous and systemic flares, and overall impact on immunological parameters.

All of the patients showed significant improvement as early as two weeks after treatment, and twelve (86%) showed a total response by end of treatment. Side effects were relatively few, and minor; e.g., gastrointestinal symptoms and insomnia.

Unfortunately, relapse after withdrawal occurred in 75% of subjects anywhere from 2 to 8 weeks later. However, side effects were generally mild, the authors report, and no patients progressed to systemic disease, while levels of anti-dsDNA antibodies and complement remained stable.

Lenalidomide might be expected to be more effective than thalidomide in the longer term, the authors observe,  if only because its mode of action is more immunomodulaing, while thalidomide’s is more antiangiogenic.

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