P161 Lenalidomide use in refractory cutaneous lupus erythematosus: a UK tertiary centre experience

Abstract

Thalidomide is an effective treatment for refractory cutaneous lupus erythematosus (CLE) but its use is frequently limited by cumulative toxicity, particularly peripheral neuropathy. Lenalidomide, a thalidomide analogue, has demonstrated comparable efficacy with improved tolerability in small case series, but remains under-reported in UK dermatology practice. Following the availability of generic lenalidomide reducing costs, its use was reviewed in a tertiary hospital managing patients with CLE. We conducted a retrospective analysis of all patients initiated on lenalidomide for CLE. Relevant data were collected from electronic records. Ten patients were commenced on lenalidomide between May 2025 and January 2026. Their median age was 52 years (range 40–65) and 90% were female. Systemic lupus erythematosus was present in 70% (five discoid, one subacute, one acute), with 30% (n = 3) having isolated discoid lupus. Autoantibody positivity was seen in 90% including anti-Ro (n = 8), anti-double-stranded DNA (n = 5), antichromatin (n = 3), anti-RNP (n = 3), anti-SM (n = 3), anti-La (n = 2) and antiribosomal (n = 1). All but one had received prior systemic therapy, including thalidomide (60%), methotrexate, mycophenolate mofetil and rituximab. Lenali­domide was initiated at 2.5 mg daily (n = 9) or 5 mg daily (n = 1). Concomitant therapy was used in 80%, most commonly hydroxychloroquine (n = 7); two patients received lenalidomide monotherapy. At the latest follow-up, 70% remained on treatment, with all demonstrating clearance or near clearance. Two patients with prior thalidomide-associated paraesthesia did not experience neuropathy on lenalidomide. Two patients discontinued within 1 month due to neuropathy (n = 1) or gastrointestinal intolerance (n = 1). One patient required temporary cessation due to new-onset lupus nephritis requiring other therapies. This real-world experience demonstrates that lenalidomide is an effective and generally well-tolerated treatment for CLE, including in patients previously limited by thalidomide toxicity. Vigilance for neuropathy and venous thromboembolism is required. Our findings are comparable with other reported case series and support consideration for wider implementation of lenalidomide in specialist UK centres managing patients with CLE.