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.
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.