Lenalidomide treatment of cutaneous lupus erythematosus: the Mayo Clinic experience

Int J Dermatol. 2016 Aug;55(8):e431-9. doi: 10.1111/ijd.13226. Epub 2016 Feb 12.

Abstract

Background: Published case series describe lenalidomide as an effective treatment of refractory cutaneous lupus erythematosus (CLE).

Objectives: The present study aimed to further characterize lenalidomide use in the treatment of CLE.

Methods: A retrospective review of patients treated with lenalidomide for CLE from January 1, 2000, to December 17, 2014, was conducted.

Results: Eight of the nine patients (89%) were women. Their median age at initiation of lenalidomide was 62 years (range: 41-86 years). Subtypes of CLE included discoid lupus erythematosus (DLE) (n = 6), lupus panniculitis (n = 2), and subacute CLE (n = 1). Before the initiation of lenalidomide, all patients had been previously treated unsuccessfully or were intolerant to at least one antimalarial and one immunosuppressive agent. With lenalidomide, five patients achieved a complete response (CR), two a partial response, and two had no response (lupus panniculitis). Time to initial response (dose range: 2.5-10.0 mg/d) varied from 2 weeks to 3 months; the median time to CR in five patients was 3 months (range: 3-6 months). The median duration of lenalidomide therapy was 12 months (range: 2-67 months). The median duration of follow-up was 48 months (range: 20-103 months). Adverse effects included mild leukopenia; one patient had deep vein thrombosis of unclear etiology during a hospitalization. No patients developed or showed progression of systemic LE while receiving lenalidomide.

Conclusions: Lenalidomide was effective for the treatment of CLE (particularly DLE) but not for the treatment of lupus panniculitis in this series.

Publication types

  • Evaluation Study

MeSH terms

  • Academic Medical Centers
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / adverse effects
  • Angiogenesis Inhibitors / therapeutic use*
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Lenalidomide
  • Lupus Erythematosus, Cutaneous / diagnosis
  • Lupus Erythematosus, Cutaneous / drug therapy*
  • Male
  • Middle Aged
  • Panniculitis, Lupus Erythematosus / diagnosis
  • Panniculitis, Lupus Erythematosus / drug therapy*
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Thalidomide / adverse effects
  • Thalidomide / analogs & derivatives*
  • Thalidomide / therapeutic use
  • Time Factors
  • Treatment Outcome

Substances

  • Angiogenesis Inhibitors
  • Thalidomide
  • Lenalidomide