Centre for Rheumatology Research, University College London, London, UK.
Lupus. 2013 Aug;22(9):932-9. doi: 10.1177/0961203313497115.
Cutaneous manifestations occur frequently in systemic lupus erythematosus (SLE) and are pathognomonic in subacute-cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus erythematosus (CCLE). Although B-cell depletion therapy (BCDT) has demonstrated efficacy in SLE with visceral involvement, its usefulness for patients with predominant skin manifestations has not been fully established. In this single-centre, retrospective study 14 consecutive SLE, one CCLE and two SCLE patients with recalcitrant skin involvement were treated with 2 × rituximab 1 g, and 1 × cyclophosphamide 750 mg. Six months after BCDT, nine of 17 (53%) patients were in complete (CR) or partial remission (PR). Relapses occurred in 12 patients (71%) at a mean time of 10 ± 1.8 months after BCDT. A second cycle of BCDT achieved a more sustained remission in seven of nine patients (78%) lasting for a mean time of 18.4 ± 2.7 months. Minor adverse events were experienced by three patients. Mean follow-up was 30 months. Our own results and the literature review demonstrate that BCDT based on rituximab is well tolerated and may be effective for cutaneous lesions of lupus erythematosus. Randomized controlled trials are necessary to further evaluate the value of BCDT for this group of patients.
皮肤表现常出现在系统性红斑狼疮（SLE）中，在亚急性皮肤型红斑狼疮（SCLE）和慢性皮肤型红斑狼疮（CCLE）中具有特征性。尽管 B 细胞耗竭疗法（BCDT）已被证明对有内脏受累的 SLE 有效，但它对主要表现为皮肤表现的患者的疗效尚未得到充分证实。在这项单中心回顾性研究中，连续纳入了 14 例 SLE、1 例 CCLE 和 2 例 SCLE 患者，这些患者均有顽固的皮肤受累，接受了 2×利妥昔单抗 1g 和 1×环磷酰胺 750mg 治疗。在 BCDT 后 6 个月，17 例患者中有 9 例（53%）达到完全缓解（CR）或部分缓解（PR）。在 BCDT 后平均 10±1.8 个月时，12 例患者（71%）出现复发。在 7 例患者（78%）中，再次接受 BCDT 后实现了更持久的缓解，缓解持续时间平均为 18.4±2.7 个月。有 3 例患者出现轻微不良反应。平均随访时间为 30 个月。我们自己的结果和文献复习表明，基于利妥昔单抗的 BCDT 耐受良好，可能对狼疮性皮疹有效。需要进行随机对照试验来进一步评估 BCDT 对这组患者的价值。
