Background/Purpose: Apremilast has been approved by the FDA for treatment of psoriasis and psoriatic arthritis. Because side effects are few, we decided to use it off-label in a number of patients with extensive cutaneous lupus rashes resistant to topical therapy and hydroxychloroquine, and as a steroid-sparing method.

Methods: We describe 6 patients with significant cutaneous lupus. 2 had subacute cutaneous lupus, and 4 had significant cutaneous lupus rashes which were chronic and associated with systemic lupus. All were treated with the topical corticosteroid clobetasol, and sometimes less-potent corticosteroid preparations for facial involvement. 2 patients were taking oral corticosteroids with a dosage range of 5 to 15. All 6 patients were taking hydroxychloroquine, 400 mg per day. The etiology of the rashes was confirmed by skin biopsy and/or Dermatology and Rheumatology clinical agreement. The mean age was 48; age range was 24 to 74. There were 3 men and 3 women.

Results: Of the 6 patients, 4 responded to apremilast, 30 mg bid, with a significant reduction in erythema and the size and extent of lesions within a 1-month period. Patients were satisfied with the amount of clearing of the lupus rash, and no significant side effects were noted. The 2 patients who did not have a significant reduction in their erythema discontinued apremilast after 6 weeks, and were placed on higher doses of steroids to help control their active lupus rash.

Conclusion: Apremilast may be an effective therapy for patients with resistant extensive rashes due to systemic lupus and subacute cutaneous lupus.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/apremilast-in-patients-with-lupus-rashes-2/