Date of this Version
Journal of the American Academy of Dermatology
Lenalidomide is a thalidomide analogue that may serve as an adjunctive therapy for treatment refractory cutaneous lupus erythematosus (CLE).
We evaluate the use of lenalidomide in CLE and describe the skin and circulating leukocyte profile of treatment refractory patients before and after treatment.
Five subjects were treated with lenalidomide in an unblinded open-label study. Immunohistochemistry of skin was performed for T-cell markers, glycosaminoglycans and CXCL10, an interferon (IFN)-inducible chemokine, before and after treatment. Immunophenotyping and measurement of IFN-inducible genes from peripheral blood mononuclear cells was also performed before and after treatment.
Four subjects demonstrated clinical improvement of their skin, however one of these responders subsequently developed symptoms of systemic lupus erythematosus. Small changes in rare circulating leukocyte subsets, plasmacytoid dendritic cells and regulatory T-cells, were observed with treatment and may correlate with clinical response. Treatment was associated with increased circulating HLA-DR expression and decreased markers of IFN-mediated pathways, regardless of clinical response.
Our results are limited by small sample size and the measurement of rare populations of circulating cell subsets.
Lenalidomide may have utility as therapy for severe, treatment refractory CLE. However, our preliminary data suggest that lenalidomide may activate T-cells and trigger systemic disease in some CLE patients. We also saw a unique histologic and circulating leukocyte phenotype in the nonresponding subject. Further characterization of the skin and circulating leukocyte profile of treatment refractory patients will improve our understanding of CLE.
NOTICE: This is the author’s version of a work that was accepted for publication in the Journal of the American Academy of Dermatology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms, may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in J Am Acad Dermatol. Apr 2012; 66(4): 571–582. doi: 10.1016/j.jaad.2011.01.015
Lenalidomide, cutaneous lupus erythematosus, CLE
Braunstein, Inbal; Goodman, Noah G.; Rosenbach, Misha; Okawa, Joyce; Shah, Asha; Krathen, Michael; Kovarik, Carrie; Prak, Eline Luning; and Werth, Victoria P., "Lenalidomide Therapy in Treatment Refractory Cutaneous Lupus Erythematosus: Histologic and Circulating Leukocyte Profile and Potential Risk of a Systemic Lupus Flare" (2012). Botswana-UPenn Scholarly Publications. 17.
Date Posted: 13 November 2014
This document has been peer reviewed.