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Original Investigation
December 2018

Assessment of Response to B-Cell Depletion Using Rituximab in Cutaneous Lupus Erythematosus

Author Affiliations
  • 1Department of Rheumatology, University College London Hospital, University College London, London, United Kingdom
  • 2Department of Internal Medicine, Centro Hospitalar do Porto, Porto, Portugal
  • 3Department of Internal Medicine, Compleio Asistencial Universitario de León, León, Spain
JAMA Dermatol. 2018;154(12):1432-1440. doi:10.1001/jamadermatol.2018.3793
Key Points

Question  What is the response to B-cell depletion therapy with rituximab in severe active cutaneous lupus erythematosus among patients with systemic disease?

Findings  This cohort study of 50 patients with cutaneous lupus erythematosus reports a complete clinical response of the cutaneous manifestations of systemic disease to rituximab of 20 patients (40%) at 6 months and 24 (52%) at 12 months. Acute cutaneous lupus erythematosus and nonspecific lupus erythematosus showed better clinical responses, whereas only 2 of 6 (33%) with subacute disease at both time points and 5 of 12 (42%) and 5 of 11 (46%) with chronic disease demonstrated a complete clinical response at 6 and 12 months, respectively.

Meaning  Study findings suggest that B-cell depletion therapy using rituximab may be effective in treating severe active cutaneous lupus erythematosus in some patients with systemic disease, especially those with acute and nonspecific types.

Abstract

Importance  Cutaneous lupus erythematosus (CLE) can be severe and treatment resistant. B-cell depletion therapy (BCDT) with rituximab is well recognized in organ involvement in systemic lupus erythematosus (SLE), but its efficacy in cutaneous manifestations is less well established.

Objective  To evaluate the outcomes of BCDT in CLE and its clinical subtypes in the setting of associated SLE.

Design, Setting, and Participants  This single-center, retrospective, cohort study was performed at the adult tertiary referral Rheumatology Department of University College London Hospital, London, United Kingdom, from January 1, 2000, through March 31, 2016, with 12-month follow-up completed on March 31, 2017. Adult patients with carefully classified CLE and mucocutaneous British Isles Lupus Assessment Group (BILAG) grade A or B who were treated with rituximab BCDT were selected from a prospective database of 709 patients with SLE. Data were analyzed from April through December 2017.

Main Outcomes and Measures  Clinical response was examined at 6 and 12 months after treatment for CLE and its subtypes acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and nonspecific LE (NSLE). A complete response was defined as achieving BILAG grade D; partial response, BILAG grade C; stable disease, no change; and disease flare, change from BILAG grade C or D to grade A or B.

Results  A total of 50 patients with SLE were eligible for inclusion; mean (SD) age at diagnosis was 26.9 (12.1) years, and 49 (98%) were women. Twenty-one patients had ACLE; 6, SCLE; 10, CCLE; and 11, NSLE (including 2 with concurrent ACLE and CCLE). Overall, at 6 months, 38 patients (76%) improved their mucocutaneous BILAG grade A or B status, including 20 (40%) with a complete response. At 12 months, 28 of 46 patients (61%) maintained this response, including 24 (52%) with a complete response. Two of 6 patients (33%) with SCLE showed a complete response at 6 and 12 months. Five of 12 patients (42%) with CCLE showed a complete response at 6 months, and 5 of 11 (45%), at 12 months. Fifteen patients (30%) required further rituximab therapy within 12 months for cutaneous involvement.

Conclusions and Relevance  B-cell depletion therapy using rituximab appears effective in patients with SLE and severe active CLE; however, outcomes are variable in those with SCLE and CCLE subtypes.

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