Therapy with rituximab for autoimmune pemphigus: Results from a single-center observational study on 42 cases with long-term follow-up - 14/09/12
, Francesca Lupi, MD a, Cinzia Masini, MD a, Rosamaria Corona, DSc, MD a, Pietro Puddu, MD a, Ornella De Pità, MD b
Reprint requests: Giuseppe Cianchini, MD, Department of Immunodermatology, Istituto Dermopatico dell’Immacolata, IRCCS, Via dei Monti di Creta 104, 00167 Rome, Italy.Abstract |
Background |
Rituximab induces depletion of B cells and has shown efficacy in antibody-mediated autoimmune disorders. In studies on small series of patients with pemphigus, rituximab administration results in significant improvement. However, differences in inclusion criteria, treatment protocols, and follow-up make it difficult to derive uniform conclusions.
Objectives |
We sought to test the efficacy and tolerability of rituximab as adjuvant therapy to corticosteroids in the treatment of pemphigus.
Methods |
In all, 42 patients with pemphigus were treated with rituximab and followed up for up to 5 years. No additional immunosuppressive agents were used. Steroids were rapidly tapered. Outcomes were the proportion of patients who achieved a complete response on or off therapy, the rate of discontinuation of corticosteroid within 6 months, length of remission, time to relapses, and occurrence of adverse events.
Results |
In all, 36 of 42 patients (86%; 95% confidence interval 75%-96%) achieved a complete response on or off therapy and discontinued steroids within 6 months from induction therapy. Six patients had a complete response off therapy with an additional infusion of rituximab 6 months after initial treatment. Twenty patients experienced a total of 34 relapses; the time to relapse was 8 to 64 months. Every relapse was treated with rituximab (500 mg) without corticosteroids, which induced a new complete response. No serious adverse events were observed.
Limitations |
Lack of a control group is a limitation.
Conclusions |
Rituximab therapy induces prolonged clinical remission in patients with pemphigus. Coadministration of other immunosuppressive agents is not necessary. Relapses can be managed with additional infusions administered on demand.
Le texte complet de cet article est disponible en PDF.Key words : adverse events, autoimmune bullous diseases, B cell–depleting treatment, immunosuppressive treatment, monoclonal antibodies, pemphigus, relapses, rituximab, therapy
Abbreviations used : IV, PF, PV, RCT
Plan
| Supported in part by current research grants of the Italian Ministero della Salute for the years 2007, 2008, and 2009, and by Project ISS-526D/1.3 of the Istituto Superiore di Sanità. |
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| Conflicts of interest: None declared. |
Vol 67 - N° 4
P. 617-622 - octobre 2012 Retour au numéro
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