Anifrolumab linked to fewer infection-related hospitalizations in skin lupus

After one year of treatment, the infection tally looked almost flat across three groups—but the consequences did not. In a Johns Hopkins Medicine-led study of 71 adults with chronic cutaneous lupus erythematosus and systemic lupus erythematosus, 0% of patients taking anifrolumab alone had an infection requiring hospitalization, compared with 32.6% among those taking conventional immunosuppressants.

Published in the Journal of the European Academy of Dermatology and Venereology, the preliminary investigator-initiated study compared three treatment groups: 46 adults on conventional immunosuppressants, 13 on anifrolumab combined with an immunosuppressant, and 12 on anifrolumab alone. Overall infection rates remained broadly comparable—65.2%, 69.2% and 66.7%, respectively—so the finding concerns the type of infection and the treatment it required, not a lower chance of any infection.

The difference was clearest in the care those infections required. Infections requiring systemic antibiotics affected 47.8% of patients on conventional immunosuppressants, compared with 38.5% of those on the combination and 8.3% of those on anifrolumab alone. Bacterial infections were reported by 50.0%, 30.8% and 8.3%, respectively. Pneumonia (15.2%) and soft-tissue infections (23.9%) appeared almost exclusively among patients taking only conventional immunosuppressants, while viral infections were more common in the anifrolumab groups.

That distinction matters because chronic skin lupus can leave permanent skin damage and hair loss, while the usual fallback treatments dampen the immune system. Anifrolumab, an FDA-approved monoclonal antibody treatment for systemic lupus, is being studied here because no specific FDA-approved treatment exists for skin lupus. Jun Kang, an assistant professor of dermatology at the Johns Hopkins University School of Medicine, says clinicians still lack a full understanding of when and how to use the drug for this condition.

Concretely, the study gives clinicians a sharper comparison when considering treatment for people with refractory skin lupus: overall infections were not lower, but the anifrolumab-only group had fewer infections requiring hospitalization or systemic antibiotics. The signal remains preliminary. It comes from one site and small treatment groups, and Kang's team says the findings should help build clearer evidence and, ultimately, new guidance rather than serve as a final answer on prescribing.