Cutaneous Lupus Erythematosus Remission and Smoking

Remission lasting more than 3 years was rare in cutaneous lupus erythematosus (CLE), according to results of a longitudinal cohort study, published in the Journal of the American Academy of Dermatology.

Patients (N=141) with CLE who had an outpatient consultation at the Tenon Hospital in France from 2019 to 2021 were enrolled in this study. Retrospective patient records and prospectively collected data on clinical presentation, treatment, and remission were evaluated for trends. Long-term remission was defined as lasting 3 or more years.

The study population comprised 81% women who were diagnosed at a median age of 31 years (interquartile range [IQR], 23-43) and 35% were active smokers.

The patients had discoid CLE (66%), subacute CEL (23%), tumidus CLE (21%), several subtypes (22%), or other subtypes (8%). Patients presented with articular manifestations (80%), lupus nephritis (24%), serositis (12%), antiphospholipid serology (8%), and neurolupus (8%). Patients had mild (57%) or moderate to severe (43%) disease, as defined by baseline CLE Disease Area and Severity Index (CLASI) score. Patients had received a median of 3 (range, 0-10) previous lines of therapy, 99% had received antimalarials, 44% immunosuppressants, 43% thalidomide and/or lenalidomide, and 38% glucocorticoids.

At a median follow-up of 11.4 years (range, 4.2-24.7), 46% of patients were receiving second- or third-line systemic treatment (46%), antimalarials at baseline dose (27%), antimalarials at a tapered dose (11%), or no systemic treatment (17%).

Remission occurred at a median time of 5.5 years. Stratified by CLASI scores, patients with scores below 10 were associated with a significantly decreased time to first remission (P <.0018).

At the final follow-up, 93 patients were in remission and were receiving antimalarials at baseline dose (n=40), second- or third-line therapy (n=29), antimalarials at a tapered dose (n=12), and no systemic treatment (n=12). Remission was associated with previous remission (odds ratio [OR], 11.5; 95% CI, 2.3-57.9; P =.003).

Long-term remission was achieved by 22 patients who were receiving second- or third-line therapy (n=7), antimalarials at a tapered dose (n=6), no systemic treatment (n=5), and antimalarials at baseline dose (n=40). Long-term remission was negatively related with discoid subtype (OR, 0.12; 95% CI, 0.03-0.41; P =.0008) and active smoking (OR, 0.14; 95% CI, 0.03-0.63; P =.02) and positively related with age at final follow-up (OR, 1.07; 95% CI, 1.02-1.12; P =.005).

The major limitation of this study was that some of the data were retrospectively collected.

These data indicated to the researchers that long-term remission among patients with CLE was rare and negatively related with smoking and discoid CLE. Encouraging patients with CLE to quit smoking may increase likelihood of achieving long-term remission.

Reference

Fayard D, Francès C, Amoura Z, et al. Prevalence and factors associated with long-term remission in cutaneous lupus: a longitudinal cohort study of 141 cases. J Am Acad Dermatol. 2022;S0190-9622(22)00549-7. doi:10.1016/j.jaad.2022.03.056