Anifrolumab for refractory discoid lupus: Two case reports of successful outcomes in Saudi Arabia

Discoid lupus erythematosus (DLE) is a chronic, refractory condition causing visible scarring and significant psychological distress. Standard treatments often fail to provide adequate relief, necessitating new therapeutic options.

A 43-year-old woman with longstanding DLE experienced recurrent scalp lesions unresponsive to multiple therapies, including high-dose corticosteroids, which caused adverse effects. A 19-year-old woman with systemic lupus erythematosus presented with persistent discoid scalp lesions, disfigurement, and emotional distress despite standard treatments.

Both patients were diagnosed with refractory DLE, confirmed by clinical findings and skin biopsies.

Both patients received monthly intravenous anifrolumab (300 mg) alongside hydroxychloroquine and methotrexate. Significant improvement was noted after the first dose, including reduced lesion severity, erythema, and itchiness, with visible hair regrowth. The first patient Cutaneous Lupus Erythematosus Disease Area and Severity Index-Activity score improved from 18 to 3, allowing complete corticosteroid discontinuation. The second patient Cutaneous Lupus Erythematosus Disease Area and Severity Index-Activity score decreased from 8 to 1. No adverse effects were reported.

These cases demonstrate anifrolumab potential as a treatment for refractory DLE, offering rapid and sustained improvement in disease severity and quality of life while reducing corticosteroid dependency. These findings suggest anifrolumab as a viable alternative for challenging DLE cases, warranting further research to confirm its efficacy and safety in larger populations.