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Background Belimumab (an anti-BLyS monoclonal antibody) was recently approved for the treatment of systemic lupus erythematosus (SLE). The aim of the study was to describe efficacy and safety of the drug as well as its impact on serologic parameters and the role of long-term systemic sparing of treatment in clinical practice in LE. Patients and methods We conducted a retrospective study at Reims University Hospital between 2012 and 2016 including consecutive patients with LE treated with belimumab. Efficacy was evaluated in terms of clinical progression, and normalisation of laboratory factors (anti-DNA antibody and C3 serum levels) and sparing of associated long-term systemic therapies for LE. Results Among the 15 patients included, a therapeutic response was obtained in 9 patients (60%), with partial remission in 8 of 9 cases. The median titre of anti-DNA antibody was 50IU/mL (range: 4-50) and the median C3 level was 0.82g/L (range: 0.36-1.23) before initiation of belimumab, vs. 25.5IU/mL (range: 2-50) and 0.89g/L (range: 0.34-1.22) at the last evaluation, respectively, without significant modification (P=0.12 and P=0.45). The median dose of prednisone at the time of the first belimumab infusion was reduced from 9.5mg/day (range: 0-18) to 6mg/day (range: 0-20) at the last clinical evaluation. Eight patients (53%) experienced adverse events, and these were very slight or moderate in all cases. Conclusion Belimumab appears to be an effective and well-tolerated treatment for moderately severe systemic LE, allowing sparing of maintenance corticosteroid therapy in order to decrease its frequent adverse events.

Introduction Le rituximab (RTX) est un anticorps anti-CD20 de plus en plus utilise dans le traitement des maladies auto-immunes dermatologiques. Il peut etre associe a un risque infectieux qui justifie, pour certaines maladies, une prevention de ce risque. A ce jour, aucun protocole n’est valide pour la majorite des indications en dermatologie. L‘objectif de cette etude etait d’evaluer les infections sous RTX et les differents facteurs associes. Materiel et methodes Nous avons realise une etude retrospective cas-temoins au sein des services de dermatologie et medecine interne du Centre Hospitalier Regional Universitaire de Nancy. Nous avons inclus tous les patients ayant recu un traitement par RTX pour une maladie auto-immune dermatologique entre 2014 et 2018. L’appariement a ete realise sur l’âge et le diagnostic. Resultats Nous avons inclus 17 cas et 17 temoins, 22 femmes (12 cas, 10 temoins) et 12 hommes (5 cas, 7 temoins), l’âge moyen etait de 50,6 ans. La cohorte etait composee des pathologies suivantes : 9 pemphigus, 4 pemphigoides cicatricielles, 8 pemphigoides bulleuses, 6 dermatomyosites/syndromes des anti-synthetases, 4 lupus et 3 purpuras vasculaires. Six cas (35,3 %) ont developpe au moins une infection contre 3 (17,6 %) temoins. En dehors de l’infection ORL, toutes ont necessite une hospitalisation et etaient considerees comme severes (grade 3 ou plus). La moitie des patients atteints de dermatomyosite (DM) ou syndrome des anti-synthetases (SAS) ont developpe une infection, de meme que deux tiers des patients atteints de purpura vasculaire, alors qu’aucun patient atteint de lupus n’a eu d’infection. Enfin, il y a eu significativement plus d’infections chez les hommes, deux tiers des patients infectes etaient des hommes. Discussion Bien que la difference ne soit pas significative, nous avons constate deux fois plus de patients infectes dans le groupe traite par RTX, dont plus de 80 % par des infections severes. La plus frequente etait la pneumopathie bacterienne, puis la pneumocystose. L’incidence des infections severes (grade 3 et plus) sous RTX est variable selon les etudes, de 2,8 a 45 % ; les infections pulmonaires sont au premier plan, suivies par les infections cutanees que nous n’avons pas constatees dans notre cohorte. La maladie sous-jacente semble aussi jouer un role, les patients atteints de DM/SAS et de purpura vasculaire ayant developpe une infection dans 50 % des cas ou plus. Certains auteurs se sont interesses a l’incidence de la pneumocystose en fonction de la pathologie sous-jacente ; la DM s’inscrit ici dans les pathologies a haut risque. Nous n’avons pas retrouve cette notion dans la litterature concernant les purpuras vasculaires. Conclusion Certaines pathologies telles que les DM/SAS et les purpuras vasculaires semblent etre a risque de complications infectieuses que le RTX pourrait aggraver. Le traitement par RTX de ces maladies pourrait faire l’objet de recommandations concernant la prevention du risque infectieux.

Belimumab (an anti-BLyS monoclonal antibody) was recently approved for the treatment of systemic lupus erythematosus (SLE). The aim of the study was to describe efficacy and safety of the drug as well as its impact on serologic parameters and the role of long-term systemic sparing of treatment in clinical practice in LE.We conducted a retrospective study at Reims University Hospital between 2012 and 2016 including consecutive patients with LE treated with belimumab. Efficacy was evaluated in terms of clinical progression, and normalisation of laboratory factors (anti-DNA antibody and C3 serum levels) and sparing of associated long-term systemic therapies for LE.Among the 15 patients included, a therapeutic response was obtained in 9 patients (60%), with partial remission in 8 of 9 cases. The median titre of anti-DNA antibody was 50IU/mL (range: 4-50) and the median C3 level was 0.82g/L (range: 0.36-1.23) before initiation of belimumab, vs. 25.5IU/mL (range: 2-50) and 0.89g/L (range: 0.34-1.22) at the last evaluation, respectively, without significant modification (P=0.12 and P=0.45). The median dose of prednisone at the time of the first belimumab infusion was reduced from 9.5mg/day (range: 0-18) to 6mg/day (range: 0-20) at the last clinical evaluation. Eight patients (53%) experienced adverse events, and these were very slight or moderate in all cases.Belimumab appears to be an effective and well-tolerated treatment for moderately severe systemic LE, allowing sparing of maintenance corticosteroid therapy in order to decrease its frequent adverse events.

Resume Introduction Le belimumab (anticorps monoclonal anti-BLyS) a ete recemment commercialise dans le traitement du lupus erythemateux (LE) systemique. Le but de cette etude etait d’en decrire l’efficacite, la tolerance, l’impact sur les parametres serologiques du LE et le role d’epargne des traitements de fond en pratique courante. Malades et methodes Cette etude retrospective menee au CHU de Reims incluait tous les malades atteints de LE traites par belimumab entre 2012 et 2016. L’efficacite du traitement etait evaluee sur l’evolution clinique, la normalisation des concentrations d’anticorps anti-DNA et de complement, et l’epargne des autres traitements du LE. Resultats Une reponse therapeutique etait obtenue chez 9 des 15 malades inclus (60 %), a type de remission partielle pour 8 d’entre eux. La concentration mediane d’anti-DNA etait de 50 UI/mL (4 a 50) et celle de C3 serique de 0,82 g/L (0,36 a 1,23) a l’instauration du belimumab, versus respectivement 25,5 UI/mL (2 a 50) et 0,89 g/L (0,34 a 1,22) a la date des dernieres nouvelles (DDN), sans modification significative (respectivement p = 0,12 et p = 0,45). La posologie mediane de prednisone a l’instauration du belimumab passait de 9,5 mg/j (0 a 18) a 6 mg/j (0 a 20) a la DDN. Huit malades (53 %) ont presente des effets secondaires, toujours minimes. Conclusion Le belimumab a eu chez 15 malades une efficacite moderee et une faible toxicite ; il a permis une epargne cortisonique moderee, en vue de limiter les effets secondaires de la corticotherapie au long cours.

Using non-steroidal anti-inflammatory drugs (NSAID) in association with a suitable antibiotherapy in the treatment of erysipelas, is still being largely discussed in medical publications. When compared to other fields of medicine, here their use might be justified by their ability to reduce local inflammation processes, to relieve patients more quickly, and to prevent potential sequels due to an inflammatory process. Numerous reports have suggested an association between the use of NSAID and the progression of an invasive streptococcal infection, particularly necrotizing fasciitis. The exact mechanism is still unclear. No controlled survey (NSAID versus placebo) checking the efficiency and the safety of these treatments is currently available. Only one comparative study showed a gain of one single day for prednisolone The prednisolone-treated patients had a shorter median length of hospital stay (5 days vs. 6) than the placebo-treated ones. The median treatment time with intravenous antibiotics, in the placebo group, was 1 day longer than in the prednisolone group. The occurrence of side effects was not higher in the prednisolone group. If this currently available data is not sufficient to establish a relationship between severe infectious complications and the use of NSAID, one should be cautious when using them to treat erysipelas, since their efficiency has not been positively proved.