Glucocorticoid-Free Induction Therapy With Hydroxychloroquine and Anifrolumab in Systemic Lupus Erythematosus: A Case Report

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder typically managed with glucocorticoids (GCs), but there are significant risks associated with their long-term use. With the new immunosuppressive agents and biologics, discontinuation of GC usage while effectively controlling disease flares has become feasible. But GC-free induction therapy in SLE remains challenging. Here, we show a 60-year-old woman diagnosed with SLE, who successfully managed her disease without GCs, using hydroxychloroquine (HCQ) and anifrolumab (ANI) as primary treatment options. The patient initially presented with symptoms including facial erythema, fever, leukocytopenia, thrombocytopenia, anaemia, proteinuria, and lymphadenitis, raising suspicion of an SLE flare. Laboratory tests and imaging confirmed the diagnosis, and a lymph node biopsy revealed necrotising lymphadenitis. A renal biopsy indicated class II lupus nephritis. Despite initial treatment with HCQ, the patient's condition did not improve. We sequentially added ANI, resulting in rapid resolution of fever, improvement in blood counts, and significant reduction in rash severity. Importantly, she did not need GCs to treat SLE. ANI is a monoclonal antibody targeting the type I interferon receptor subunit 1 and can be a key drug for SLE. The findings suggest that GC-free induction therapy can be an approach for controlling disease activity in SLE.