Lenalidomide treatment of cutaneous lupus erythematosus: the Mayo Clinic experience.

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.