Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
The Use of Lenalidomide for Cutaneous Manifestations of SLE.
Wu, Eveline, E. Schanberg, Laura, VanMater, Heather, C. Rabinovich, Egla
Cutaneous manifestations are common in pediatric SLE and cause significant morbidity. In the past, thalidomide has proved effective in the treatment of cutaneous disease. Its use, however, is limited by its teratogenecity and the potential for peripheral neuropathy. Lenalidomide, a thalidomide analogue, has shown promise with a more favorable side effect profile. Though their mechanism of action is not completely understood, both appear to have anti-inflammatory and immunomodulatory properties. Our objective was to evaluate the efficacy and safety of lenalidomide in the treatment of cutaneous SLE.
We performed a retrospective chart review of 5 children who received lenalidomide for treatment of cutaneous aspects of SLE. Lenalidomide dosing was 515 mg daily. One subject was initially taking thalidomide 100 mg daily. Patients were evaluated at drug initiation and at 6 month follow up using a standardized case report form. Statistical analysis was performed using the paired t-test. If a significant value was obtained (P<0.05), further statistical analysis was performed using Wilcoxon's signed rank test.
All of our subjects were female and 80% were African-American. Average age at diagnosis was 12.4 years (SD +/- 3.5). Average age at time of lenalidomide or thalidomide initiation was 16.4 years (SD +/- 4.7). Subjects started the medications for treatment of skin disease, including alopecia, nasal and oral ulcers, extensive malar rash, diffuse maculo-papular eruption, discoid lesions, bullous lesions, panniculitis, and severe Raynaud's phenomenon with digital ulcerations. One patient initially received thalidomide before switching to lenalidomide 28 months later due to complaints of numbness over her anterior shin with a normal EMG. Within the first 6 months, all 5 subjects demonstrated excellent response with resolution of skin lesions. Lenalidomide maintained the remission in skin disease achieved by thalidomide in the one patient. No subject relapsed on continued therapy. Prednisone dose was decreased in all patients, from a mean of 23 mg (SD +/- 10.9) to a mean of 11 mg (SD +/- 7.4) at 6 months (P=0.005). ESR also decreased from a mean of 26.2 mm/hr (SD +/- 8.9) to a mean of 19.2 mm/hr (+/- 7.5) at 6 months (P=0.015). The results remained statistically significant with analysis using Wilcoxon's signed rank test. One patient with nephritis started IVIG during the follow up period. Others did not start a new DMARD, further supporting the positive effect of lenalidomide on prednisone dose and ESR. Both medications exhibited a favorable side effect profile. All patients had lymphopenia, but this was not statistically significant during the 6 month evaluation. One patient developed pyelonephrits.
Skin disease is highly prevalent among children with SLE and can be quite disfiguring. Lenalidomide is both effective and safe for the treatment of a spectrum of dermatologic conditions in pediatric SLE. Its use may allow for a reduction in prednisone dose. Prospective study of lenalidomide is needed to clarify its role in the treatment of cutaneous manifestations of SLE.
To cite this abstract, please use the following information:
Wu, Eveline, E. Schanberg, Laura, VanMater, Heather, C. Rabinovich, Egla; The Use of Lenalidomide for Cutaneous Manifestations of SLE. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1699