da Costa RQ, et al. - Researchers appraised the outcomes of B-cell depletion therapy (BCDT) using rituximab in cutaneous lupus erythematosus (CLE) and its clinical subtypes in the setting of associated systemic lupus erythematosus (SLE). In this cohort study of 50 patients with cutaneous lupus erythematosus, 20 patients (40%) reported a complete clinical response of the cutaneous manifestations of systemic disease to rituximab at 6 months and 24 (52%) reported a complete clinical response at 12 months. Better clinical responses were evident in patients with acute cutaneous lupus erythematosus and nonspecific lupus erythematosus. Outcomes thus suggest B-cell depletion therapy using rituximab as efficacious in treating severe active cutaneous lupus erythematosus in some patients with systemic disease, especially those with acute and nonspecific types.

Methods

• From January 1, 2000, through March 31, 2016, researchers performed a single-center, retrospective, cohort study at the adult tertiary referral Rheumatology Department of University College London Hospital, London, United Kingdom, with 12-month follow-up completed on March 31, 2017.
• From a prospective database of 709 patients with SLE, they selected adult patients with carefully classified CLE and mucocutaneous British Isles Lupus Assessment Group (BILAG) grade A or B who were treated with rituximab BCDT.
• They analyzed data from April through December 2017.
• At 6 and 12 months after treatment, they examined clinical response for CLE and its subtypes acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and nonspecific LE (NSLE).
• Achieving BILAG grade D defined a complete response; achieving BILAG grade C defined partial response; no change defined stable disease; and change from BILAG grade C or D to grade A or B defined disease flare,.

Results

• Eligibility for inclusion was fulfilled by a total of 50 patients with SLE; mean (SD) age at diagnosis was 26.9 (12.1) years, and 49 (98%) were women.
• Among these, 21 patients had ACLE; 6, SCLE; 10, CCLE; and 11, NSLE (including 2 with concurrent ACLE and CCLE).
• Overall, at 6 months, mucocutaneous BILAG grade A or B status improved in 38 patients (76%); these patients include 20 (40%) patients who displayed a complete response.
• At 12 months, this response remained maintained in 28 of 46 patients (61%), including 24 (52%) with a complete response.
• At 6 and 12 months, a complete response was noted in 2 of 6 patients (33%) with SCLE.
• A complete response was observed in 5 of 12 patients (42%) with CCLE at 6 months, and 5 of 11 (45%), at 12 months.
• Further rituximab therapy was required in 15 patients (30%) within 12 months for cutaneous involvement.