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Systematic Review: Monoclonal Antibody-Induced Subacute Cutaneous Lupus Erythematosus
Chrissy Bolton1,2,3, Yifan Chen4, Rachel Hawthorne5
1University College London, University College London Hospitals NHS Foundation Trust, London, UK. Christine.bolton@nhs.net.
Drugs in R&D
|September 22, 2020
Summary
Subacute cutaneous lupus erythematosus (SCLE) can be triggered by monoclonal antibodies (mAbs). Checkpoint inhibitors and anti-tumour necrosis factor-alpha agents show elevated SCLE rates, aiding in understanding this condition.
Area of Science:
- Dermatology
- Immunology
- Pharmacology
Background:
- Subacute cutaneous lupus erythematosus (SCLE) lacks established diagnostic criteria and its pathogenesis remains unclear.
- Increasing reports link SCLE to monoclonal antibody (mAb) use, yet data on etiology, clinical features, and prognosis are limited.
Purpose of the Study:
- To establish diagnostic criteria for SCLE.
- To systematically review and characterize mAb-induced SCLE, including triggers, clinical presentation, and outcomes.
Main Methods:
- A multinational panel developed consensus diagnostic criteria for SCLE.
- A systematic review of five databases identified 52 cases of mAb-induced SCLE from 40 publications.
- Global commercial data and therapy costs were modeled to estimate relative mAb usage.
Main Results:
- SCLE occurred in 52 patients (73% female, median age 61 years), with 50% linked to anti-tumour necrosis factor-alpha agents.
- Lesions appeared after a median of three drug doses and resolved in a median of 7 weeks post-cessation.
- Checkpoint inhibitors (pembrolizumab, nivolumab) showed disproportionately high SCLE rates relative to their usage.
Conclusions:
- This is the first systematic review characterizing mAb-induced SCLE, detailing triggers, clinical signs, and treatment.
- Elevated SCLE rates are associated with checkpoint inhibitors and anti-tumour necrosis factor-alpha agents.
