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• W2023280167 abstract "To the Editor: Patients with cutaneous lupus erythematosus (CLE) are frequently intolerant or refractory to traditional first-line treatment with antimalarials, and 10% remain recalcitrant to immunosuppressives or thalidomide.1Housman T.S. Jorizzo J.L. McCarty M.A. Grummer S.E. Fleischer A.B. Sutej P.G. Low-dose thalidomide therapy for refractory cutaneous lesions of lupus erythematosus.Arch Dermatol. 2003; 139: 50-54Crossref PubMed Scopus (73) Google Scholar, 2Moghadam-Kia S. Chilek S. Gaines E. Costner M. Rose M.E. Okawa J. et al.Cross-sectional analysis of a collaborative Web-based database for lupus erythematosus-associated skin lesions: prospective enrollment of 114 patients.Arch Dermatol. 2009; 145: 255-260Crossref PubMed Scopus (47) Google Scholar Thalidomide use is limited by side effects, including peripheral neuropathy and teratogenicity, and we thus studied lenalidomide (Revlimid), a thalidomide analog.3Cortes-Hernandez J. Avila G. Vilardell-Tarres M. Ordi-Ros J. Efficacy and safety of lenalidomide for refractory cutaneous lupus erythematosus.Arthritis Res Ther. 2012; 14: R265Crossref PubMed Scopus (51) Google Scholar, 4Bastuji-Garin S. Ochinsky S. Bouche P. Gherardi R.K. Duguet C. Djerradine Z. et al.Incidence and risk factors for thalidomide neuropathy: a prospective study of 135 dermatologic patients.J Invest Dermatol. 2002; 119: 1020-1026Crossref PubMed Scopus (143) Google Scholar In a case series in which patients with severe CLE were treated with lenalidomide, 4 of 5 patients showed at least a partial response.5Braunstein I. Goodman N.G. Rosenbach M. Okawa J. Shah A. Krathen M. et al.Lenalidomide therapy in treatment-refractory cutaneous lupus erythematosus: histologic and circulating leukocyte profile and potential risk of a systemic lupus flare.J Am Acad Dermatol. 2012; 66: 571-582Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar The present study represents the longitudinal data from this initial case series. In a prospective, open-label trial, we investigated the use of lenalidomide in 5 refractory, biopsy-proven cases of CLE in patients with or without systemic involvement. Subjects took 5 mg daily of oral lenalidomide for the initial 6 weeks. At 6 weeks, the dose was lowered to 5 mg every other day in patients who had responded; dose was increased to 10 mg daily in nonresponders. The primary endpoints were the change in the Cutaneous Lupus Area and Severity Index (CLASI), quality of life (QoL) measures (Skindex-29), and side effects. Physician and patient's global assessments, as well as pain, itch, and fatigue scores, were measured on a 10-point visual analog scale. All 5 patients experienced at least a 4-point decrease in CLASI activity at 12 weeks, which met the minimally clinical important difference. Activity scores improved from a mean of 21.4 at week 0 before treatment to a mean of 10.8 at week 6 and 8.6 at week 12 of treatment. Subject 2 experienced a 10-point decrease in activity score at week 12 on the higher dose of 10 mg daily. This patient thought that the result was clinically inadequate, and she was withdrawn from the study. Subject 5 had an 18-point decrease in CLASI activity; however, she was withdrawn at week 20 after arthralgias and new-onset proteinuria developed. In the 3 remaining patients, activity scores continued to improve throughout the 52 weeks (Fig 1). Personal skin scores improved from a mean of 6 at week 0 before treatment to a mean of 3 at week 6 and a mean of 3.8 at week 12. Skin scores continued to improve for the 3 patients who remained in the trial at 52 weeks. These findings correspond to improved physician impression scores throughout the duration of treatment. Itch scores, as well as all 3 QoL parameters improved for these 3 patients. Lenalidomide was well tolerated in all but one patient. This patient (patient 5) may have been predisposed to the development of systemic lupus erythematosus (SLE), in that she was the only subject to report arthralgias at baseline. Electromyography performed before and after treatment showed no new or exacerbations of peripheral neuropathies, and subject 3's EMG showed moderate improvement after treatment. Lenalidomide is a potential therapy that has more potent anti–tumor necrosis factor activity than thalidomide, possibly without the risk of peripheral neuropathy. Patients with signs of systemic disease may not be candidates for therapy. This study is limited by the small sample size and lack of a randomized control. Even so, our results suggest that lenalidomide should be considered as a potentially valuable entity in the treatment of antimalarial-resistant CLE." @default.
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• W2023280167 date "2014-03-01" @default.
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• W2023280167 title "Lenalidomide in treatment-refractory cutaneous lupus erythematosus: Efficacy and safety in a 52-week trial" @default.
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• W2023280167 doi "https://doi.org/10.1016/j.jaad.2013.11.007" @default.
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