B-Cell Depletion Therapy With Rituximab Effective for Cutaneous Lupus Erythematosus

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Although patients with CCLE responded well, the numbers were small and additional research with respect to this finding is warranted.
Although patients with CCLE responded well, the numbers were small and additional research with respect to this finding is warranted.

Rituximab appears to be an effective treatment in patients with systemic lupus erythematosus (SLE) and severe, active cutaneous lupus erythematosus (CLE), although outcomes among those with subacute CLE (SCLE) and chronic CLE (CCLE) subtypes vary. Results of the single-center, retrospective cohort study were published in JAMA Dermatology.

The investigators sought to explore outcomes linked to the use of B-cell depletion therapy (BCDT) in CLE and its clinical subtypes in the setting of associated SLE. The current study was performed between January 1, 2000, and March 31, 2016, with a 12-month follow-up completed on March 31, 2017. Adult patients with CLE and mucucutaneous British Isles Lupus Assessment Group (BILAG) grade A or B who received treatment with rituximab BCDT were chosen from a prospective database of 709 individuals with SLE. Data analysis occurred from April through December 2017.

The primary study outcome was overall cutaneous response to BCDT at 6 months and 12 months. The secondary outcome was the cutaneous response according to different CLE subtypes — that is, acute CLE (ACLE), SCLE, CCLE, and nonspecific LE (NSLE) — at 6 months and 12 months. The researchers also evaluated those patients who required additional cycles of rituximab during the 12-month follow-up. Participants' responses were described as follows: (1) a complete response was defined as attaining BILAG grade D; (2) a partial response was defined as achieving BILAG grade C; (3) stable disease was defined as experiencing no change; and (4) disease flare was defined as a change from BILAG grade C or D to BILAG grade A or B.

A total of 50 patients with SLE were eligible for inclusion in the study. Overall, 49 of the 50 patients were women; the mean age at diagnosis was 26.9±12.1 years. ACLE was reported in 21 patients, CCLE in 10 patients, NSLE in 11 patients (which included 2 who had concurrent ACLE and CCLE), and SCLE in 6 patients.

At 6 months, 76% (38 of 50) of participants had improved their BILAG grade A or B status, which included 40% (20 of 50) who experienced a complete response. At 12 months, 61% (28 of 46) of participants maintained this response, which included 52% (24 of 46) of patients who experienced a complete response. Moreover, 33% (2 of 6) of patients with SCLE demonstrated a complete response at 6 months and 12 months.

Additionally, 42% (5 of 12) of participants with CCLE demonstrated a complete response at 6 months, with 45% (5 of 11) of these participants demonstrating a complete response at 12 months. Overall, 30% (15 of 50) of patients required additional rituximab therapy within 12 months because of cutaneous involvement.

The investigators concluded that the results of this study revealed good clinical response to BCDT using rituximab in patients with all forms of mucocutaneous involvement, particularly among those with ACLE and NSLE. Although patients with CCLE responded well, the numbers were small and additional research with respect to this finding is warranted. Major limitations of the current study include its retrospective design and the small numbers of patients included within each CLE subgroup.

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Reference

Quelhas da Costa R, Aguirre-Alastuey ME, Isenberg DA, Saracino AM. Assessment of response to B-cell depletion using rituximab in cutaneous lupus erythematosus. JAMA Dermatol. 2018;154:1432-1440.

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