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Lim D, Kleitsch J, Werth VP. Emerging immunotherapeutic strategies for cutaneous lupus erythematosus: an overview of recent phase 2 and 3 clinical trials. Expert Opin Emerg Drugs 2023; 28:257-273. [PMID: 37860982 DOI: 10.1080/14728214.2023.2273536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Cutaneous lupus erythematosus (CLE) is an autoimmune disease that is clinically heterogenous and may occur with or without the presence of systemic lupus erythematosus (SLE). While existing on a spectrum, CLE and SLE present differences in their underlying pathogenesis and therapeutic responses. No new therapies have been approved in recent decades by the U.S. Food and Drug Administration for CLE, although frequently refractory to conventional therapies. There is an unmet need to develop effective drugs for CLE as it significantly impacts patients' quality of life and may leave irreversible disfiguring damage. AREAS COVERED This review provides an update on the latest phase 2 and 3 clinical trials performed in CLE or SLE using skin-specific outcome measures. Emergent therapies are presented alongside their mechanism of action as recent translational studies have permitted identification of critical targets among immune cells and/or pathways involved in CLE. EXPERT OPINION While the recent literature has few trials for CLE, drugs targeting type I interferon, its downstream signaling and plasmacytoid dendritic cells have shown promising results. Further research is required to develop long-awaited effective therapies, and this review highlights the importance of implementing trials dedicated to CLE to fill the current gap in CLE therapeutics.
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Affiliation(s)
- Darosa Lim
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
- Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Julianne Kleitsch
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
- Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria P Werth
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
- Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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Buie J, Bloch L, Morand EF, van Vollenhoven RF, Werth VP, Touma Z, Lipsky P, Kalunian K, Askanase AD, Ines L, Reed C, Son M, Franson T, Costenbader K, Schanberg LE. Meeting report: the ALPHA project: a stakeholder meeting on lupus clinical trial outcome measures and the patient perspective. Lupus Sci Med 2023; 10:e000901. [PMID: 37537705 PMCID: PMC9930541 DOI: 10.1136/lupus-2023-000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
Drug development in lupus has improved over the past 10 years but still lags behind that of other rheumatic disease areas. Assessment of prospective lupus therapies in clinical trials has proved challenging for reasons that are multifactorial including the heterogeneity of the disease, study design limitations and a lack of validated biomarkers which greatly impacts regulatory decision-making. Moreover, most composite outcome measures currently used in trials do not include patient-reported outcomes. Given these factors, the Addressing Lupus Pillars for Health Advancement Global Advisory Committee members who serve on the drug development team identified an opportunity to convene a meeting to facilitate information sharing on completed and existing outcome measure development efforts. This meeting report highlights information presented during the meeting as well as a discussion on how the lupus community may work together with regulatory agencies to simplify and standardise outcome measures to accelerate development of lupus therapeutics.
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Affiliation(s)
- Joy Buie
- Research, Lupus Foundation of America, Washington, District of Columbia, USA
| | - Lauren Bloch
- Health Policy and Regulatory Affairs, Faegre Drinker Biddle and Reath LLP Washington, Washington, District of Columbia, USA
| | - Eric F Morand
- Rheumatology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center ARC, Amsterdam, The Netherlands
| | - Victoria P Werth
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zahi Touma
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Lipsky
- RILITE Research Institute, Charlottesville, Virginia, USA
| | | | - Anca D Askanase
- Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - L Ines
- Faculty of Health Sciences, Univ Beira Interior, Covilha, Portugal
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - MaryBeth Son
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Karen Costenbader
- Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Gaffney RG, Werth VP, Merola JF. Cutaneous lupus erythematosus disease assessment: Highlighting CLE outcome measures. Front Med (Lausanne) 2022; 9:968469. [PMID: 36314023 PMCID: PMC9614355 DOI: 10.3389/fmed.2022.968469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Victoria P. Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States,Corporal Michael J. Crescenz Veteran's Administration Medical Center (VAMC), Philadelphia, PA, United States
| | - Joseph F. Merola
- Harvard Combined Dermatology Program, Boston, MA, United States,Division of Rheumatology, Department of Dermatology and Medicine, Brigham and Women's Hospital, Boston, MA, United States,*Correspondence: Joseph F. Merola
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Drenkard C, Barbour KE, Greenlund KJ, Lim SS. The Burden of Living With Cutaneous Lupus Erythematosus. Front Med (Lausanne) 2022; 9:897987. [PMID: 36017007 PMCID: PMC9395260 DOI: 10.3389/fmed.2022.897987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous lupus erythematosus (CLE) is a group of heterogeneous autoimmune disorders primarily affecting the skin. Patients with these conditions are mostly young women when they become sick and often suffer from recurrent skin symptoms or longstanding changes in their physical appearance. CLE disorders lead to different levels of morbidity and can impact profoundly patients' quality of life, particularly in the psychological and social health domains. This review provides a summary of recent research investigating the psychosocial burden of living with CLE and the intersect amongst the disease characteristics, patient factors, and social determinants of health. Furthermore, this review provides insight into patient care and research needs that remain unmet to improve the quality of life of patients living with CLE.
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Affiliation(s)
- Cristina Drenkard
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA, United States
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- *Correspondence: Cristina Drenkard
| | - Kamil E. Barbour
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kurt J. Greenlund
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - S. Sam Lim
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA, United States
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Drenkard C, Theis KA, Daugherty TT, Helmick CG, Dunlop-Thomas C, Bao G, Aspey L, Lewis TT, Lim SS. Depression, stigma and social isolation: the psychosocial trifecta of primary chronic cutaneous lupus erythematosus, a cross-sectional and path analysis. Lupus Sci Med 2022; 9:e000697. [PMID: 35953237 PMCID: PMC9379542 DOI: 10.1136/lupus-2022-000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Depression is common in individuals with chronic cutaneous lupus erythematosus (CCLE). However, how CCLE may impact patients' psychological well-being is poorly understood, particularly among disproportionally affected populations. We examined the relationships between depression and psychosocial factors in a cohort of predominantly Black patients with primary CCLE (CCLE without systemic manifestations). METHODS Cross-sectional assessment of individuals with dermatologist-validated diagnosis of primary CCLE. NIH-PROMIS short-forms were used to measure depression, disease-related stigma, social isolation and emotional support. Linear regression analyses (ɑ=0.05) were used to test an a priori conceptual model of the relationship between stigma and depression and the effect of social isolation and emotional support on that association. RESULTS Among 121 participants (87.6% women; 85.1% Black), 37 (30.6%) reported moderate to severe depression. Distributions of examined variables divided equally among those which did (eg, work status, stigma (more), social isolation (more), emotional support (less)) and did not (eg, age, sex, race, marital status) significantly differ by depression. Stigma was significantly associated with depression (b=0.77; 95% CI0.65 to 0.90), whereas social isolation was associated with both stigma (b=0.85; 95% CI 0.72 to 0.97) and depression (b=0.70; 95% CI0.58 to 0.92). After controlling for confounders, stigma remained associated with depression (b=0.44; 95% CI0.23 to 0.66) but lost significance (b=0.12; 95% CI -0.14 to 0.39) when social isolation (b=0.40; 95% CI 0.19 to 0.62) was added to the model. Social isolation explained 72% of the total effect of stigma on depression. Emotional support was inversely associated with depression in the univariate analysis; however, no buffer effect was found when it was added to the multivariate model. CONCLUSION Our findings emphasise the psychosocial challenges faced by individuals living with primary CCLE. The path analysis suggests that stigmatisation and social isolation might lead to depressive symptoms. Early clinical identification of social isolation and public education demystifying CCLE could help reduce depression in patients with CCLE.
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Affiliation(s)
- Cristina Drenkard
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Kristina A Theis
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Timothy T Daugherty
- Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Charmayne Dunlop-Thomas
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gaobin Bao
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Aspey
- Department Medicine/Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tené T Lewis
- Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
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