Long-term remission rare outcome in cutaneous lupus erythematosus

Researchers found that long-term remission of cutaneous lupus erythematosus occurred in nearly 20% of patients, according to a study published in the Journal of American Academy of Dermatology.

Damien Fayard, MD, of Sorbonne Université in Paris, and colleagues wrote that cutaneous lupus erythematosus (CLE) is generally divided into subtypes including acute, subacute and chronic. Chronic CLE includes a further subtype known as discoid CLE (DLE).

To assess the prevalence and factors associated with remission and long-term remission with and without treatment during CLE, the researchers conducted a longitudinal cohort study that included 141 patients (median age at diagnosis, 31 years; 81% women).

The most common subtype among patients was DLE (n = 66%).

After a median follow-up from diagnosis of 11.4 years (range, 4.2-24.7 years), 65 patients were on a second- or third-line systemic treatment with or without hydroxychloroquine (HCQ) or chloroquine (CQ), 27% were treated with HCQ only, 14 were on HCQ with a tapered dose and 24 had no systemic treatment.

At the last follow-up, 66% of patients achieved remission. Median duration of remission was 15 months.

However, only 19% of 114 patients achieved long-term remission based on at least 3 years of follow-up, including five patients with no systemic treatment.

Patients who achieved long-term remission were significantly older compared with those who did not.

Multivariable analysis showed that a previous episode of remission correlated with achieving remission (OR = 11.5; 95% CI, 2.3-57.9).

In contrast, active smoking (OR = 0.22; 95% CI, 0.05-0.99) and DLE subtype (OR = 0.12; 95% CI, 0.03-0.41) correlated with a lower rate of long-term remission.

The researchers also found that patients who achieved long-term remission were more frequently treated with a tapered dose of antimalarials (OR = 7.29; 95% CI, 1.35-39.2).

“Smoking cessation should be one of the main targets in the therapeutic management of CLE patients,” Fayard and colleagues concluded. “Moreover, after remission, tapering or stopping HCQ seems possible in about 25% of CLE patients, and does not seem associated with a higher rate of relapse.”