Rituxan May Be Effective at Treating Cutaneous Lupus Erythematosus, Study Suggests

Rituxan (rituximab), a medicine that is often used to treat systemic lupus erythematosus (SLE), may also be effective at treating skin lesions in patients with cutaneous lupus erythematosus (CLE), a study suggests.

Researchers found that one year after treatment, 61% of patients experienced improvements in their skin lesions, and more than half had a complete resolution of these lesions.

The study, “Assessment of Response to B-Cell Depletion Using Rituximab in Cutaneous Lupus Erythematosus,” was published in the journal JAMA Dermatology.

Lupus, as an autoimmune disease, can affect many organs and systems in the body. CLE is when the immune system specifically affects the skin, and it can be divided into several subtypes, such as acute and subacute, based on the severity of the disease and the specific location of the inflammation.

B-cells play a primary role in the progression of lupus as they produce auto-reactive antibodies — antibodies that target the body’s own cells, rather than invaders such as bacteria or viruses. Rituxan, a treatment that targets B-cells, has been investigated as a possible treatment for SLE patients, but results to date have failed to prove its efficacy — in part because of poorly designed early trials.

In addition, whether Rituxan is effective for CLE has not been thoroughly investigated. To address this question, investigators reviewed the clinical records of 50 CLE patients who had been treated with Rituxan at the Rheumatology Department of University College London Hospital between 2000 and 2016.

Patients were given intravenous Rituxan twice over two weeks; patients were also given cyclophosphamide, a chemotherapeutic sometimes used to suppress the immune system in lupus patients, in accordance with the hospital’s guidelines at the time of treatment.

After six months, 38 patients (76%) had at least some response to treatment, with 20 (40%) showing complete responses, all of which persisted at 12 months of treatment. Most of those with partial responses (57%) maintained their response at 12 months as well, although 43% required additional treatment for the worsening of their disease.

Certain subtypes of CLE also appeared more likely to respond to Rituxan. For example, more patients with acute CLE and nonspecific lupus erythematosus achieved a complete response (57% in both groups) compared with patients with subacute (33%) or chronic CLE (45%).

These findings suggest that Rituxan might be more beneficial for those with acute disease, possibly because other subtypes of CLE are caused by alternative immune pathways not involving B-cells. However, the low number of patients makes it difficult to draw sweeping conclusions from this single study.

“Overall, our results show good clinical response to [B-cell-depleting therapy] using rituximab in all forms of mucocutaneous involvement, especially in patients with [acute CLE] and [nonspecific lupus erythematosus],” the researchers wrote.

Further studies with larger sample numbers will be needed to investigate fully the effectiveness of B cell-depleting therapy in treating CLE.