“Most patients will respond well to these conservative therapies, but there are 10%–20% of patients with refractory disease who don't respond,” she said. For such patients, there are a range of other treatment options, including thalidomide, dapsone, retinoids, biologics, and immunosuppressants.
“Some of these more aggressive therapies are associated with significant side effects, and should be used sparingly and only when warranted by disease severity,” Dr. Werth said.
“Unfortunately, there is a paucity of data in the literature to aid the clinician in terms of which therapies to employ. Often, the presumed efficacy of these drugs has often been extrapolated from their use in treating systemic lupus.”
It is hoped that new insights into the genetic pathways associated with cutaneous lupus, as well as continued advances in targeted biologic therapies, will lead to the development of more selective, less toxic therapeutic agents.
Among the drugs currently in development, Dr. Werth said, “are a derivative of thalidomide and a new B-cell-specific monoclonal antibody therapy.”