TOPLINE: 

In a small study, women with cutaneous lupus erythematosus (CLE) experienced an increased risk for disease flares during late perimenopause, particularly the year before their final menstrual period, and flares remained elevated after menopause.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 64 women aged ≥ 45 years with CLE (median age at CLE onset, 35 years) seen between January 2021 and July 2023 in Paris.
• Participants reported the date of their final menstrual period, menstrual history, climacteric symptoms, and menopausal hormone therapy use with standardized questionnaires.
• Follow-up was grouped into prespecified 1-year intervals around the final menstrual period, including perimenopause (2 years preceding menopause), early post menopause (1 year after menopause), with a reference year at age 40. Median age at last follow-up was 55 years.
• Treatment intensification during defined yearly windows around the final menstrual period served as a proxy for flares. Researchers assessed whether the menopausal transition affected CLE activity and whether CLE activity decreased after menopause.

TAKEAWAY:

• By the last follow-up, 49 patients (77%) were postmenopausal; the median age at menopause was 50 years, and 82% reported climacteric symptoms. Most (90%) had chronic CLE, and 48% met systemic lupus erythematosus (SLE) classification criteria.
• Treatment intensification was significantly more frequent during the year immediately preceding menopause (odds ratio [OR], 3.07; 95% CI, 1.11-8.47); 45% of patients required intensification vs 24% at baseline.
• Compared with the reference period, no significant reduction in treatment intensification was observed at the last follow-up (OR, 1.71; 95% CI, 0.67-4.40), suggesting persistent disease activity after menopause.

IN PRACTICE:

"Overall, we found a significant increase in CLE flares during late perimenopause," the authors concluded, noting that "it has been suggested that hormonal imbalance preceding menopause may account for these flares." Moreover, they added, "the absence of a decreased flare rate at last follow-up suggests that CLE activity persists after menopause."

SOURCE:

The study was led by Quentin Allibert, MD, Alexandre Teboul, MD, MSc, and François Chasset MD, PhD, Sorbonne Université, Faculté de médecine, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris; and Hélène Collinot, MD, PhD, Hospital Bicêtre, Department of Gynecology and Obstetrics, Le Kremlin Bicêtre, France; Faculty of medicine, University Paris-Sud Saclay, andwas published online on June 8 in JAAD International.

LIMITATIONS:

The study has several methodological constraints, including its retrospective design, which may have introduced recall bias in patient-reported menopausal data; the absence of longitudinal Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity scoring; and sex hormone measurements. 

DISCLOSURES:

The study was supported by the French Ministry of Health. One author disclosed receiving grant and research support from AstraZeneca, BMS, and GSK. He also reported participating in advisory boards for lupus-related topics with AstraZeneca, GSK, Celgene, Merck, Horizon Therapeutics, Novartis, Kyowa Kirin, and Principabio, and receiving speaking fees and honoraria from AstraZeneca, GSK, and BMS related to lupus. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.