Objectives To evaluate the efficacy and usefulness of anti-B-cell therapy with rituximab (RTM) in patients with different subtype of skin manifestations of lupus erythematosus (LE) refractory to standard therapy during the long-term follow-up.
Methods 32 patients with various subtype of skin manifestation of LE were included in our study: generalized acute cutaneous LE was observed in 6, subacute cutaneous LE in 7, butterfly rash in 7, panniculitis in 1, discoid lupus erythematosus in 2, ulcerative vasculitis in 9 patients. Mucosal LE was observed in 23 patients. The median age of the patients was 27 [21-40] years, the duration of the diseases was 44 [17-84] months. Before the treatment of the disease SLEDAI2K was 20 [15-27], the concentration of a-dsDNA was 61,5 [24,6-111] U/ml, C3 was 0,58 [0,49-0,76] g/l, C4 was 0,1 [0,08-0,15] g/l, the concentration of B-cells was 6,6 [3,5-14,7]%. Previous puls-therapy was not effective in 66% of patients who received the cyclophosphamide (CF) and high dosage of glucocorticoids (GC), in 34% of patients who received previous therapy with mycofemolate mofetil (MFM) and azathioprine (AZA).
Only 1 course of RTM received 19 patients, 2 courses - 5 patients, 3 courses - 5 patients, 4 courses – 3 patients. After the first course of RTM 30 patients received maintenance therapy with cytostatics and hydroxychloroquine: CF-10, AZA-1, MFM - 4 patients and hydroxychloroquine received 5 patients. CF was changed to AZA in 3 patients after the 3 months of the therapy. 1 patient received combined therapy with CF and MFM.
Results During the long-term follow-up (12 [12-24] months, from 6 to 48 months) the repeated courses of rituximab were effective in 84% of patients (complete response in 56%, partial response in 28%) and were not effective in 16% of patients. The B-cell depletion was observed in 72% of patients during a month after the therapy with RTM. The mean time of B-cell recovery was 6 [1-12] months. The exacerbations were noticed in 25% of patients during 12 [6-21] months of follow-up.
Reducing signs of skin manifestations occurred gradually with the following sequence: the most rapid effect was observed in subacute LE, generalized acute cutaneous LE, discoid LE and further in ulcerative vasculitis. Complete response was observed in 60% of patients during a month after the first course of anti-B-cell therapy.
During the long-term follow-up we observed the improvements of disease activity by SLEDAI2K, concentrations of a-dsDNA and components of the complement, decreasing the daily dosage of glucocorticoids.
Conclusions Rituximab has demonstrated efficacy in different subtype of skin manifestations of lupus erythematosus refractory to standard treatment during long-term follow-up. We noticed gradually improvement of skin manifestations symptoms: the most rapid effect was observed in subacute LE, generalized acute cutaneous LE, discoid LE and further in ulcerative vasculitis.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.