USE OF UPADACITINIB IN 2 CASES OF REFRACTORY SYSTEMIC LUPUS ERYTHEMATOSUS

PV301 / #634 Case Report Poster Topic: AS24 - SLE-Treatment Introduction Upadacitinib, a selective JAK inhibitor, is under evaluation in clinical trials alone and in combination with elsubrutinib for systemic lupus erythematosus (SLE). In our cohort, it has been employed off-label in 2 refractory cases of SLE with promising outcomes. Case Presentation With Investigation Two female patients with long-standing, refractory SLE were treated with upadacitinib 15 mg/day after multiple therapeutic failures. Clinical history, prior treatments, response to upadacitinib, and disease activity were analyzed. Literature Review • Case 1: A 54-year-old woman with SLE involving articular, hematological, cutaneous, and neurological (lupus headache) domains, alongside severe fatigue meeting chronic fatigue syndrome criteria. The patient failed conventional treatments, including belimumab. Upadacitinib 15 mg/day was initiated, resulting in complete disease remission and significant improvement in fatigue and headache. The patient has sustained remission for 18 months. • Case 2: A 59-year-old woman with a 39-year history of SLE predominantly involving articular, cutaneous, hematological, and serosal domains. After multiple treatments, including methotrexate, leflunomide, mycophenolate, belimumab, rituximab, anifrolumab, and off-label baricitinib, she exhibited persistent disease activity. Upadacitinib 15 mg/day was started, leading to low disease activity within 3 months. However, the patient continues to require corticosteroids. Discussion Upadacitinib may represent a promising therapeutic option for refractory SLE, achieving disease remission or low disease activity in patients unresponsive to conventional and biological therapies. Further studies are needed to evaluate its safety and efficacy in broader SLE populations.