Rituximab for treatment-refractory pemphigus and pemphigoid: A case series of 17 patients - 13/08/11
, Iakov Shimanovich, MD a, Ralf J. Ludwig, MD a, Christian Rose, MD a, Detlef Zillikens, MD a, Enno Schmidt, MD, PhD a, b
Reprint requests: Michael Kasperkiewicz, MD, Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.Abstract |
Background |
Rituximab has been increasingly used in autoimmune blistering dermatoses, mainly in pemphigus. However, only a few larger case series are available on this subject and information on the efficacy of retreatment with rituximab during relapses is lacking.
Objective |
We sought to determine efficacy and adverse effects of adjuvant rituximab.
Methods |
Seventeen patients with refractory autoimmune blistering dermatoses (pemphigus vulgaris [PV], n = 8; pemphigus foliaceus [PF], n = 2; bullous pemphigoid [BP], n = 2; mucous membrane pemphigoid, n = 5) were treated 4 times with rituximab at an individual dose of 375 mg/m2 in weekly intervals or twice with 1000 mg 2 weeks apart. Six of 8 patients with a relapse after this regimen received rituximab again twice with 1000 mg in a 2-week interval.
Results |
All lesions cleared in 14 patients (7 PV, two PF, two BP, 3 mucous membrane pemphigoid), whereas partial healing was found in 3 others (one PV, two mucous membrane pemphigoid). Relapses occurred in 8 patients (5 PV, two PF, one BP). Retreatment with rituximab again resulted in complete (two PV, one PF, one BP) or partial (two PV) remission. Serious side effects associated with rituximab were not observed.
Limitations |
Rituximab has been combined with various other immunosuppressive or immunomodulatory treatments.
Conclusion |
Adjuvant rituximab is effective and well tolerated not only in patients with pemphigus but also with pemphigoid. Efficacy and safety of rituximab are maintained when it is readministered during relapses.
Le texte complet de cet article est disponible en PDF.Key words : autoantibody, pemphigoid, pemphigus, rituximab, therapy
Abbreviations used : BP, MMP, PF, PV
Plan
| Supported by the Schleswig-Holstein Cluster of Excellence in Inflammation Research (DFG EXC 306/1). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. |
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| Disclosure: Drs Shimanovich, Rose, Zillikens, and Schmidt attended a consensus meeting about the use of rituximab in autoimmune blistering disorders in March 2006 sponsored by Roche. Drs Zillikens and Schmidt received honoraria from Roche. Drs Kasperkiewicz and Ludwig have no conflicts of interest to declare. |
Vol 65 - N° 3
P. 552-558 - septembre 2011 Retour au numéro
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