Session Information
Date: Tuesday, October 23, 2018
Title: Systemic Lupus Erythematosus – Clinical Poster III: Treatment
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Skin lesions of lupus may be refractory to standard therapy. Apremilast is an orally small molecule which inhibits phosphodiesterase-4 (PDE-4) that modulates some inflammatory pathways. Our aim was to assess the efficacy of apremilast in lupus rashes refractory to conventional treatment.
Methods:
We set up a retrospective study on 6 lupus patients treated with apremilast at standard dose of 30 mg twice daily, with the initial 5-day titration schedule. The outcome was improvement of lupus rashes.
Results:
We studied 6 patients (5 women/1 male); mean age, 40.6±11.5 years with extensive skin lesions due to lupus. Three patients had a discoid lupus and other three patients had systemic lupus erythematosus (SLE) (one with panniculitis, one with polycyclic ring lupus and the other one with psoriasiform lupus). The cutaneous lupus was confirmed in all patients by skin biopsy.
Prior to apremilast all patients had received conventional treatment: topical corticosteroids (n=6), antimalarials (n=6), topical tacrolimus (n=3), oral corticosteroids (n=3), thalidomide (n=1), belimumab (n=2) and rituximab (n=2).
The duration of the cutaneous lesions until Apremilast onset was 148±90.6 months. After a mean follow-up of 6.2±2.9 months, all the patients experienced improvement of the skin lesions (in two patients was complete). In one patient it was necessary to reduce the dose of apremilast to 30 mg/day because of digestive symptoms (diarrhoea and vomiting) (TABLE).
Conclusion:
Apremilast can be useful in the treatment of refractory skin lesions of lupus.
TABLE
|
Apremilast onset |
Apremilast follow-up |
||||||||
|
Patient |
Age/Sex |
Skin lesions |
Previous treatments |
Months from diagnosis to Apremilast onset
|
Antinuclear Antibody (ANA) |
Simultaneous treatment |
Months from Apremilast onset |
Adverse effects |
Discontinued |
Response |
|
1 |
46 / Female |
Polycyclic ring lupus |
Prednisone Hydroxychloroquine Thalidomide Belimumab, RTX
|
300 |
ANA 1/1280 |
Prednisone |
2 |
diarrhoea |
No |
Partial |
|
2 |
45 / Female |
Lupus panniculitis |
Prednisone Hydroxychloroquine |
156 |
ANA 1/1280 |
Prednisone Hydroxychloroquine |
7 |
No |
No |
Complete |
|
3 |
36 / Male |
Discoid lupus |
Prednisone Hydroxychloroquine |
ND |
ANA (-) |
Prednisone Hydroxychloroquine |
6 |
Diarrhoea vomiting |
No. 30 mg/24 h |
Complete |
|
4 |
57 / Female |
Discoid lupus |
Prednisone Hydroxychloroquine |
72 |
ANA (-) |
Prednisone Hydroxychloroquine |
6 |
No |
No |
Complete |
|
5 |
37 / Female |
Discoid lupus |
Prednisone Hydroxychloroquine |
120 |
ANA (-) |
Prednisone Hydroxychloroquine |
10 |
No |
No |
Complete |
|
6 |
23 / Female |
Psoriasiform lupus |
Prednisone Topical Tacrolimus Hydroxychloroquine Belimumab, RTX
|
92 |
ANA 1/160 |
Prednisone Hydroxychloroquine |
4 |
No |
No |
Partial |
+ RTX = Rituximab; ANA: Antinuclear antibody.
To cite this abstract in AMA style:
Martín-Varillas JL, Atienza-Mateo B, Loricera J, Calderón Goercke M, Prieto Peña D, Armesto S, Cuende E, González-Vela C, Hernández JL, González-Gay MA, Blanco R. Apremilast As Treatment of Refractory Skin Lupus Lesions [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/apremilast-as-treatment-of-refractory-skin-lupus-lesions/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/apremilast-as-treatment-of-refractory-skin-lupus-lesions/