PO:17:259 | Anifrolumab: a new management of SLE

Background. to report a case of severe cutaneous Systemic Lupus Erythematosus (SLE) successfully treated with a combination of Cyclosporine and Anifrolumab, followed by biologic monotherapy. Materials and Methods. we describe the case of a 50-year-old woman with a 20-year history of SLE, characterized by severe cutaneous involvement, leukopenia, Raynaud's phenomenon, arthralgia, hypocomplementemia, positive ANA (titer 1:1280), and anti-dsDNA antibodies. The patient had experienced prolonged disease remission under treatment with hydroxychloroquine, low-dose prednisone (5 mg/day), and methotrexate (12.5 mg/week). In February 2023, she presented with a disease flare marked by erythematous, desquamative lesions in sun-exposed areas, rising anti-dsDNA levels, and persistently low complement levels. Increasing prednisone to 12.5 mg/day failed to control the flare, and subcutaneous belimumab (200 mg/week) was initiated. Two weeks later, the patient developed severe erythematous-desquamative lesions involving the trunk, face, scalp, and mucous membranes (oral and genital), suggestive of Lyell’s syndrome with secondary skin infection. High-dose corticosteroids, intravenous immunoglobulins, antibiotics, and antifungal agents were promptly administered, leading to clinical improvement after discontinuation of belimumab. In September 2023, while on prednisone 12.5 mg/day, the patient was referred to our department for another flare with worsening cutaneous lesions (erythematous and discolored areas on the face, trunk, and upper limbs) and alopecia. Disease activity was assessed as SLEDAI 4, SLEDAS 5.98 and CLASI 36. Cyclosporine (200 mg/day) was initiated, resulting in partial clinical improvement, although marked xerosis persisted. A skin biopsy confirmed discoid lupus erythematosus. Due to gastrointestinal intolerance and elevated blood pressure, cyclosporine dosage could not be increased. In December 2023, intravenous anifrolumab (300 mg/month) was added while continuing cyclosporine. Results. after three months of combined therapy, the patient showed marked clinical improvement, as indicated by a reduction in CLASI-A score (16). Anifrolumab was well tolerated with no major adverse events. Noticeable regression of skin lesions began after the second to third infusion and continued, leading to near-complete resolution over the following months. No serious adverse events occurred; only mild upper respiratory infections were observed, resolving quickly with short-course antibiotic therapy. Conclusions. in our experience, Anifrolumab has demonstrated excellent clinical efficacy in SLE patients with cutaneous and articular involvement. It provided a rapid and sustained response, enabling steroid tapering and showing a favorable safety profile with only mild adverse effects.