PMID- 25707733
OWN - NLM
STAT- MEDLINE
DCOM- 20150807
LR  - 20210109
IS  - 2326-5205 (Electronic)
IS  - 2326-5191 (Linking)
VI  - 67
IP  - 6
DP  - 2015 Jun
TI  - Brief report: responses to rituximab suggest B cell-independent inflammation in 
      cutaneous systemic lupus erythematosus.
PG  - 1586-91
LID - 10.1002/art.39085 [doi]
AB  - OBJECTIVE: The immunopathogenesis of systemic lupus erythematosus (SLE) is 
      heterogeneous, and responses of skin to rituximab are variable. This study was 
      undertaken to determine the phenotype of rituximab-responsive disease. METHODS: 
      Eighty-two patients with SLE who were receiving rituximab were prospectively 
      studied. Of these patients, 32 had significant skin involvement before or after 
      treatment. Disease activity was assessed using the British Isles Lupus Assessment 
      Group (BILAG) index 2004. Cutaneous lupus subtype was classified by a 
      dermatologist as acute cutaneous lupus erythematosus (ACLE), subacute cutaneous 
      lupus erythematosus (SCLE), chronic cutaneous lupus erythematosus (CCLE), or 
      other skin diseases, with supportive photographs or biopsies where necessary. 
      RESULTS: Of 26 patients with skin disease at baseline, 9 (35%) had a beneficial 
      mucocutaneous response to rituximab at 6 months, with good responses in ACLE (6 
      of 14 patients [43%]), and poor responses in CCLE (0 of 8 patients) (P = 0.034). 
      Clinical response was associated with anti-RNP negativity (P = 0.024) and anti-Ro 
      negativity (P = 0.031). Flares of SCLE and CCLE occurred in 12 patients who 
      either had no skin disease or had ACLE at baseline (i.e., a switch in subtype). 
      Concomitant antimalarials or conventional immunosuppressants were not associated 
      with response or flare rate. Posttreatment biopsies confirmed typical active SLE 
      histology in lesions occurring during B cell depletion. CONCLUSION: Our findings 
      indicate that the clinical response to rituximab in cutaneous manifestations of 
      SLE depends on subtype. None of the CCLE patients responded, and new CCLE lesions 
      were observed during B cell depletion, suggesting that initiation and activity of 
      these lesions is not B cell dependent. Flares of a range of skin diseases after B 
      cell depletion may indicate a change in immune regulation following B 
      cell-targeted therapy.
CI  - (c) 2015, American College of Rheumatology.
FAU - Vital, Edward M
AU  - Vital EM
AD  - NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, and 
      University of Leeds, Leeds, UK.
FAU - Wittmann, Miriam
AU  - Wittmann M
AD  - NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, and 
      University of Leeds, Leeds, UK, and Bradford Teaching Hospitals NHS Foundation 
      Trust, Bradford, UK.
FAU - Edward, Sara
AU  - Edward S
AD  - Leeds Teaching Hospitals NHS Trust, Leeds, UK.
FAU - Md Yusof, Md Yuzaiful
AU  - Md Yusof MY
AD  - NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, and 
      University of Leeds, Leeds, UK.
FAU - MacIver, Helen
AU  - MacIver H
AD  - Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
FAU - Pease, Colin T
AU  - Pease CT
AD  - NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, and 
      University of Leeds, Leeds, UK.
FAU - Goodfield, M
AU  - Goodfield M
AD  - NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, and 
      University of Leeds, Leeds, UK.
FAU - Emery, Paul
AU  - Emery P
AD  - NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, and 
      University of Leeds, Leeds, UK.
LA  - eng
GR  - 18475/VAC_/Versus Arthritis/United Kingdom
GR  - 18475/ARC_/Arthritis Research UK/United Kingdom
GR  - DRF-2014-07-155/DH_/Department of Health/United Kingdom
GR  - RTF/01/097/DH_/Department of Health/United Kingdom
GR  - CS-2013-13-032/DH_/Department of Health/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Arthritis Rheumatol
JT  - Arthritis & rheumatology (Hoboken, N.J.)
JID - 101623795
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Immunosuppressive Agents)
RN  - 4F4X42SYQ6 (Rituximab)
SB  - IM
MH  - Antibodies, Monoclonal, Murine-Derived/therapeutic use
MH  - Antirheumatic Agents/therapeutic use
MH  - B-Lymphocytes/*immunology/pathology
MH  - Cohort Studies
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Lupus Erythematosus, Cutaneous/drug therapy/*immunology/pathology
MH  - Lupus Erythematosus, Systemic/drug therapy/*immunology/pathology
MH  - Prospective Studies
MH  - Rituximab
MH  - Skin/*immunology/pathology
MH  - Treatment Outcome
EDAT- 2015/02/25 06:00
MHDA- 2015/08/08 06:00
CRDT- 2015/02/25 06:00
PHST- 2014/09/23 00:00 [received]
PHST- 2015/02/17 00:00 [accepted]
PHST- 2015/02/25 06:00 [entrez]
PHST- 2015/02/25 06:00 [pubmed]
PHST- 2015/08/08 06:00 [medline]
AID - 10.1002/art.39085 [doi]
PST - ppublish
SO  - Arthritis Rheumatol. 2015 Jun;67(6):1586-91. doi: 10.1002/art.39085.