Interventions for cutaneous disease in systemic lupus erythematosus

Area of Science:

• Dermatology
• Rheumatology
• Autoimmune Diseases

Background:

• Cutaneous lupus erythematosus (CLE) is a common manifestation of systemic lupus erythematosus (SLE), impacting patient morbidity.
• Various interventions exist for SLE, but their efficacy, risks, and benefits for cutaneous disease vary.

Purpose of the Study:

• To systematically assess the effects of interventions for cutaneous disease in systemic lupus erythematosus (SLE).

Main Methods:

• Conducted a comprehensive literature search across multiple databases up to June 2019, with an update in September 2020.
• Included 61 randomized controlled trials (RCTs) involving 11,232 participants, focusing on interventions for cutaneous SLE.
• Primary outcomes included complete and partial clinical response; secondary outcomes were flares and adverse events, with evidence quality assessed using GRADE.

Main Results:

• Hydroxychloroquine demonstrated probable superiority over placebo in reducing clinical flares at 6 months (moderate-quality evidence).
• Methotrexate may be superior to placebo for complete clinical response (absence of malar/discoid rash) at 6 months (low-quality evidence).
• Limited data and low-to-moderate quality evidence were noted for most comparisons, with significant risk of bias in reporting and performance/detection.

Conclusions:

• Current evidence supports hydroxychloroquine, chloroquine, and methotrexate for CLE treatment, though findings require cautious interpretation due to limited study numbers and evidence quality.
• There is a need for head-to-head intervention trials comparing treatments for specific CLE subtypes.
• Thirteen additional trials are awaiting classification and may influence future conclusions.