Current treatment for cutaneous lupus erythematosus (CLE) commonly focuses on photoprotection, topical therapies, corticosteroids, antimalarial drugs, and immunosuppressive drugs. More recently, B-cell depleting therapies, such as rituximab, have shown promise in treating systemic lupus erythematosus, though the feasibility of treating CLE with rituximab has not been well described.
Current treatment for cutaneous lupus erythematosus (CLE) commonly focuses on photoprotection, topical therapies, corticosteroids, antimalarial drugs, and immunosuppressive drugs. More recently, B-cell depleting therapies, such as rituximab, have shown promise in treating systemic lupus erythematosus (SLE), though the feasibility of treating CLE with rituximab has not been well described. Now, a paper newly published in JAMA Dermatology reports on one of the largest cohorts of rituximab-treated patients with SLE and response according to CLE subtype.
The retrospective observational study included 709 patients with SLE who were treated at the University College London Hospital in the United Kingdom between 2000 and 2016. Patients were enrolled through the center’s database.
In total, 150 of these patients were treated with rituximab; 57 patients in this treatment group had mucocutaneous British Isles Lupus Assessment Group (BILAG) grades of A or B, and 50 were included in the analysis. With respect to CLE subtypes, acute CLE (ACLE) was most prevalent (46%), while 6 patients had subacute CLE (SCLE) features (12%), 10 had chronic CLE (CCLE) (24%), and 11 had nonspecific SLE (NSLE) (22%).
Ten of the patients had previous rituximab treatment, and 40 were rituximab naïve. In total, 46 patients received 2 infusions of 1 g of rituximab, and 4 patients received a single infusion due to adverse events or logistical considerations.
At 6 months after treatment, 38 patients (76%) demonstrated a clinical response, and 20 (40%) demonstrated a complete response. Those with the NSLE subtype had the highest proportion (45%) of patients with a BILAG grade reduction to D. Of the remaining patients, 18 (36%) had a partial response and 8 (16%) had stable disease.
At 12 months after infusion, 28 (61%) of the 46 patients with follow-up available demonstrated clinical response, 24 (52%) demonstrated complete response, and the ACLE and SSLE subtypes had similarly high response rates of 57% and 60%, respectively.
At 6 months, 5 (88%) of the patients with SCLE and 10 (83%) of the patients with CCLE demonstrated a clinical response, including complete response in 2 (33%) patients in the SCLE group and 5 (42%) of patients in the CCLE group.
At 12 months, 3 (50%) of patients with SCLE and 7 (64%) of patients with CCLE demonstrated clinical response, including complete response in 2 (33%) and 5 (45%) patients in the 2 groups, respectively.
Of the 50 patients who received rituximab, 32 (64%) required an additional treatment cycle either during or after the follow-up period, however.
While the study was limited by its retrospective nature and the small number of patients within each CLE subtype, the authors concluded that their results show good clinical response to B-cell depletion with rituximab in all forms of mucocutaneous involvement with SLE, especially in patients with ACLE and NSLE. While patients with CCLE responded well, their small numbers warrant further study.
Reference
Quelhas da Costa R, Aguirre-Alastuey E, Isenberg DA, Saracino AM. Assessment of response to B-cell depletion using rituximab in cutaneous lupus erythematosus [published online October 31, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.3793.
Patient Perceptions of Switching From the Reference Adalimumab to Amjevita During its Initial Launch
April 20th 2024In a survey of patients with autoimmune arthritis who had been switched from reference adalimumab (Humira) to biosimilar adalimumab-atto (Amjevita; Amgen), most reported preferring the biosimilar and had no concerns about switching.
Decoding the Patent Puzzle: Navigating the Legal Landscape of Biosimilars
March 17th 2024On this episode of Not So Different, Ha Kung Wong, JD, an intellectual patent attorney and partner at Venable LLP, details the confusing landscape that is the US patent system and how it can be improved to help companies overcome barriers to biosimilar competition.
Biosimilars Rheumatology Roundup for February 2024—Podcast Edition
March 3rd 2024On this episode of Not So Different, The Center for Biosimilars® revisited all the major rheumatology biosimilar news from February 2024, including the FDA approval of the 10th adalimumab biosimilar, the promise for an oral delivery system for ustekinumab, and the impact of adalimumab products on COVID-19 antibodies.
What Clinicians Need to Know About Using Biosimilars to Treat IBD
April 13th 2024A review article, intended to act as a guide for clinicians, summarizes the available infliximab and adalimumab biosimilars for treating inflammatory bowel disease (IBD) as well as others that are coming down the pipeline.
Global Biosimilar Market Projected to Reach $1.3 Trillion by 2032
April 11th 2024The global biosimilar market is projected to surge from $25.1 billion in 2022 to approximately $1.3 trillion by 2032, with a compound annual growth rate of 17.6%, driven mainly by the increasing prevalence of cancer and the cost-effectiveness of biosimilars, as outlined in a report by Towards Healthcare.