SAT0200 Effects of B cell depletion therapy on cutaneous lupus
Authors: S.C. Hofmann, M.J. Leandro, S. Morris, D.A. Isenberg
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Systemic lupus erythematosus (SLE), subacute-cutaneous lupus (SCLE), and cutaneous lupus (CLE) are autoimmune disorders with a myriad of cutaneous manifestations which may present a therapeutic challenge. B cell depletion therapy (BCDT) with rituximab has demonstrated efficacy in SLE with visceral involvement. However, its usefulness for patients with major skin involvement has not been fully established. <h3>Objectives</h3> The aim of this study was to investigate the response of lupus-associated skin lesions in patients treated with BCDT at University College London Hospital since 2007. <h3>Methods</h3> 15 SLE patients with severe skin involvement (discoid lupus in 7, maculopapular rashes in 3, SCLE-like lesions in 1, and vasculitis or panniculitis in 4 patients), 2 SCLE patients, and 1 CLE patient were assessed in the study (1 man, 17 women; age 22-74 yrs.; 7 whites, 9 Afro-Caribbeans, 2 Asians). The median disease duration was 10 months (range 1-30 yrs.) and previous treatments included oral steroids, hydroxychloroquine, and immunosuppressants. All patients received 2 x rituximab 1000 mg and methylprednisolone 100 mg 2 weeks apart, and 1 x cyclophosphamide 750 mg. Clinical outcome was monitored using the mucocutaneous component of the BILAG activity index, anti-dsDNA antibodies, C3, and CD19 counts. Complete response (CR) was defined as absence of skin lesions (mucocutaneous BILAG D) for at least 2 months and treatment with ≤5mg prednisolone ± hydroxychloroquine. Partial remission (PR) was defined as improvement of cutaneous manifestations (BILAG C) of at least 50% or complete clearance of skin lesions (BILAG D) with continuation of immunosuppressants after BCDT. Stable disease was defined as no or only minor improvement of cutaneous lesions (mucocutaneous BILAG A or B). Median follow-up was 27 months. <h3>Results</h3> PR was achieved in 7 (39%) and CR in 7 patients (39%) after 1 cycle of BCDT, while 4 patients had stable disease (22%). In 9 patients with elevated dsDNA antibodies and/or low C3 levels pre-treatment, a median decrease of anti-dsDNA from 359 to 95 IU/ml (normal &lt;50) was observed and an increase of C3 levels from 0,81 to 1,03 g/L (normal 0,9-1,8). Adverse events were experienced by 4 patients (urticaria post-infusion, recurrent infections). Median time to B cell repopulation was 7 months (3-18) and median time to relapse 8 months (3-24). 9 patients received a 2nd or 3rd cycle of BCDT resulting in CR in 3 (33%) and PR in 4 patients (44%). 2 SLE patients with stable disease after the 1st BCDT cycle again failed to achieve remission after the 2nd cycle. In total, 5 patients (2 with discoid lupus, 2 with maculopapular rashes, 1 with vasculitis) maintained CR for more than 12 months (28%). Retreatment led to a more sustained response (median time to relapse in patients with CR or PR increased from 6 months after 1st cycle of BCDT to 23 months after 2nd or 3rd cycle). <h3>Conclusions</h3> BCDT based on rituximab was relatively well tolerated, and induced PR or CR of cutaneous lesions in 78% of patients with 28% achieving a long-lasting CR with regard to skin lesions. BCDT may therefore be considered as therapeutic option in lupus patients with cutaneous lesions refractory to standard treatment. <h3>References</h3> Lu T et al, Arthritis and Rheumatism, 2009. Turner-Stokes T et al, Rheumatology 2011. <h3>Disclosure of Interest</h3> None Declared