Rituximab in the Treatment of Pemphigus Vulgaris
Open Access
- 15 November 2012
- journal article
- review article
- Published by Springer Science and Business Media LLC in Dermatology and Therapy
- Vol. 2 (1), 1-13
- https://doi.org/10.1007/s13555-012-0017-3
Abstract
Introduction Rituximab is increasingly used in patients with pemphigus vulgaris (PV) who are nonresponders to conventional therapy. Methods A PubMed search was conducted using the words pemphigus vulgaris and rituximab therapy from papers published between 2000 and 2012. Two protocols were used. In the lymphoma protocol, patients received four weekly infusions of rituximab (dose 375 mg/m2). The rheumatoid arthritis (RA) protocol consisted of two infusions of 1,000 mg each 15 days apart. The variables recorded from each study included clinical remission off or on therapy, relapse rate, incidence of serious adverse events, concomitant therapies, duration of follow-up, and when available, levels of B cells and autoantibodies. Results Forty-two studies were found, which reported 272 patients; 180 were treated by the lymphoma protocol and 92 by the RA protocol. Both protocols were effective in treating recalcitrant PV. The lymphoma protocol had a lower response rate, relapse rate and serious infections, but higher mortality, and there were nonresponders. The RA protocol produced a higher response rate, relapse rate, number of infections, but lower mortality rate, and lacked nonresponders. The cumulative follow-up for patients treated with the lymphoma protocol was 15.44 months (range 1–41) and 21.04 months (range 8.35–29) for the RA protocol. A major concern in both protocols was the high infection rates, some of which were fatal. A different protocol using a combination of rituximab with intravenous immunoglobulin in a defined manner with a definitive endpoint, used in a limited cohort of patients, showed promising results. Conclusion Neither protocol produced a sustained clinical remission and both required continued systemic therapy. Before initiation of treatment, physicians should have a specific goal and endpoint and be aware of its potential side effects and lack of information on its long-term effects. Patients should be carefully monitored during and after therapy.Keywords
This publication has 81 references indexed in Scilit:
- Anti-CD20 Antibody Therapy for B-Cell LymphomasThe New England Journal of Medicine, 2012
- Sustained inhibition of progressive joint damage with rituximab plus methotrexate in early active rheumatoid arthritis: 2-year results from the randomised controlled trial IMAGEAnnals Of The Rheumatic Diseases, 2011
- Retreatment with rituximab based on a treatment-to-target approach provides better disease control than treatment as needed in patients with rheumatoid arthritis: a retrospective pooled analysisRheumatology, 2011
- Updated consensus statement on the use of rituximab in patients with rheumatoid arthritisAnnals Of The Rheumatic Diseases, 2011
- Efficacy and safety of different doses and retreatment of rituximab: a randomised, placebo-controlled trial in patients who are biological naive with active rheumatoid arthritis and an inadequate response to methotrexate (Study Evaluating Rituximab's Efficacy in MTX iNadequate rEsponders (SERENE))Annals Of The Rheumatic Diseases, 2010
- Efficacy and safety of various repeat treatment dosing regimens of rituximab in patients with active rheumatoid arthritis: results of a Phase III randomized study (MIRROR)Rheumatology, 2010
- Targeted Immunotherapy with Rituximab Leads to a Transient Alteration of the IgG Autoantibody Profile in Pemphigus VulgarisDermatology Research and Practice, 2010
- Consensus statement on definitions of disease, end points, and therapeutic response for pemphigusJournal of the American Academy of Dermatology, 2008
- Rituximab Therapy of Recalcitrant Bullous DermatosesJournal of Dermatological Case Reports, 2008
- External iliac artery thrombosis associated with the ilio-inguinal approach in the management of acetabular fractures: a case reportJournal of Medical Case Reports, 2008