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Multicenter Study
. 2018 Dec;79(6):1053-1060.e3.
doi: 10.1016/j.jaad.2018.06.040. Epub 2018 Jun 30.

Natural history of disease activity and damage in patients with cutaneous lupus erythematosus

Khor Jia Ker  1 , Noelle M Teske  2 , Rui Feng  3 , Benjamin F Chong  4 , Victoria P Werth  5
Affiliations
Multicenter Study

Natural history of disease activity and damage in patients with cutaneous lupus erythematosus

Khor Jia Ker et al. J Am Acad Dermatol. 2018 Dec.

Abstract

Background: Long-term studies characterizing disease course of cutaneous lupus erythematosus (CLE) patients on standard-of-care treatments are lacking.

Objective: We characterized and compared disease course of CLE patients using Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI).

Methods: In total, 83 CLE patients with CLASI scores collected from ≥3 study visits within 2 years had disease activity and damage trends calculated by average change scores (ACS). Trends were classified as improved (ACS ≤-3), worsened (ACS ≥3), or stable (-3 < ACS < 3). Linear regression models compared CLASI trends between groups.

Results: Most patients (72.73%) with initial CLASI activity (CLASI-A) scores >9 (N = 33) had improved disease activity versus 14.00% of those with initial CLASI-A scores ≤9 (N = 50). Linear regression analyses showed significant improvement in CLASI-A scores in patients of minority races (P < .05), with baseline CLASI-A scores >9 (P < .0001), baseline CLASI damage (CLASI-D) scores ≥10 (P = .0001), and CLE disease duration ≤1 year (P = .01). Of 28 patients with baseline CLASI-D scores ≥10, 35.71% had improvements in damage, while 5.26% of patients with initial CLASI-D scores of 5-9 (N = 19) and 0% with initial CLASI-D scores <5 (N = 36) (P = .0005) had improvements.

Limitations: Limitations include small sample size.

Conclusion: Baseline CLASI-A score >9, minority race, and short disease duration predict CLE disease activity improvement. A baseline CLASI-D score ≥10 is associated with disease damage improvement.

Keywords: Cutaneous Lupus Disease Area and Severity Index; cutaneous lupus erythematosus; disease activity; disease damage; longitudinal.

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Conflict of interest statement

Conflicts of interest: Dr Chong has received research grants (paid to his institution) from Biogen Incorporated and Daavlin Corporation. Dr Chong is an investigator for Pfizer Incorporated and has also received an honorarium from Celgene Corporation. Dr Werth has received research grants from Celgene Corporation, Janssen, Pfizer, Biogen, Corbus Pharmaceuticals, LuCIN, Genentech, Syntimmune, and AstraZeneca and honoraria from Celgene, Medimmune, Resolve, Neovacs, ACI, Immune Pharmaceuticals, Genetech, Idera, Octapharma, BSL Behring, Janssen, Lilly, Pfizer, Biogen, BMS, Biostrategies, Gilead, Amgen, Medscape, Principia, Nektar, Syntimmune, Incyte, and EMD Sorona. The University of Pennsylvania owns the copyright for the Cutaneous Lupus Erythematosus Disease Area and Severity Index. The remaining authors have no conflicts of interest to disclose.

Figures

Fig 1.
Fig 1.
CLASI-A scores over time for cutaneous lupus erythematosus patients with improving, stable, or worsening disease activity. The following are examples of the disease course of a patient each with improved (A), stable (B), and worsened (C) disease activity over time. CLASI-A, Cutaneous Lupus Erythematosus Disease Area and Severity Index activity; Pt, patient.
Fig 2.
Fig 2.
CLASI-D scores over time for cutaneous lupus erythematosus patients with improving, stable, and worsening disease damage. The following are examples of the disease course of a patient each with improved (A), stable (B), and worsened (C) skin damage over time. CLASI-D, Cutaneous Lupus Erythematosus Disease Area and Severity Index damage; Pt, patient.
See this image and copyright information in PMC

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