Efficacy and safety of rituximab therapy in patients with pemphigus vulgaris: first report from Turkey

Int J Dermatol. 2016 Dec;55(12):1362-1368. doi: 10.1111/ijd.13400. Epub 2016 Sep 22.

Abstract

Background: Pemphigus vulgaris (PV) is a severe, chronic, and potentially life-threatening autoimmune blistering disease that affects the skin and mucous membranes. Rituximab is a monoclonal anti-CD20 antibody which has been used increasingly in the therapy of PV.

Methods: The present study sought to test the efficacy and safety of rituximab as an adjuvant therapy by retrospective analysis of clinical and immunological data for 29 patients with PV who were treated with rituximab between 2010 and 2015. Response to therapy, duration of clinical remission, serology of the response, and adverse effects of rituximab were evaluated.

Results: The mean ± standard deviation (SD) follow-up time was 17.48 ± 13.18 months. In all patients, findings showed either a decrease in antibody titers or that antibodies were completely undetectable after therapy. Rituximab use resulted in a significant reduction in steroid dosage during follow-up. At the end of the follow-up period, 26 patients (96.2%) had achieved complete remission with or without therapy (one patient had no follow-up and one patient had died, most probably as the result of a thromboembolic event). In 44.4% of patients, a clinical relapse occurred after a mean ± SD period of 13.1 ± 4.7 months after the initiation of rituximab therapy. Relapses were managed with additional infusions of rituximab.

Conclusions: Rituximab is a beneficial and relatively safe adjuvant treatment for PV that facilitates prolonged clinical remission and has a significant steroid-sparing effect.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents / administration & dosage
  • Autoantibodies / blood*
  • Desmoglein 1 / immunology
  • Desmoglein 3 / immunology
  • Disease-Free Survival
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Immunoglobulin G / blood
  • Immunologic Factors / adverse effects
  • Immunologic Factors / therapeutic use*
  • Male
  • Methylprednisolone / administration & dosage
  • Middle Aged
  • Pemphigus / blood*
  • Pemphigus / drug therapy*
  • Recurrence
  • Remission Induction
  • Retrospective Studies
  • Rituximab / adverse effects
  • Rituximab / therapeutic use*
  • Severity of Illness Index
  • Turkey
  • Young Adult

Substances

  • Anti-Inflammatory Agents
  • Autoantibodies
  • DSG1 protein, human
  • DSG3 protein, human
  • Desmoglein 1
  • Desmoglein 3
  • Immunoglobulin G
  • Immunologic Factors
  • Rituximab
  • Methylprednisolone