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In refractory cases, third-line options typically include thalidomide, lenalidomide, belimumab, and intravenous immunoglobulin (IVIG), with mixed case series supporting use of anifrolumab, rituximab, deucravacitinib, litifilimab, plasmapheresis or photopheresis, and baricitinib

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However, it cannot be legally imported without a special permit under the strict Special Access Scheme, which requires a doctor to apply to the TGA for permission to treat a particular patient with the drug, including describing the specific clinical need