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Journal of the American Academy of Dermatology
Volume 68, n° 3
pages 404-411 (mars 2013)
Doi : 10.1016/j.jaad.2012.08.010
accepted : 10 August 2012
Original Articles

Successful treatment of pemphigus with biweekly 1-g infusions of rituximab: A retrospective study of 47 patients

Yael A. Leshem, MD a, b, Emmilia Hodak, MD a, b, Michael David, MD a, b, Grant J. Anhalt, MD c, Daniel Mimouni, MD a, b,
a Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel 
b Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 
c Department of Dermatology, Johns Hopkins University, School of Medicine, Baltimore, Maryland 

Reprint requests: Daniel Mimouni, MD, Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel 49100.

Rituximab is increasingly being appreciated as a remarkably effective treatment for pemphigus, mostly concomitantly with other immunosuppressive medications. The majority of studies have used a single cycle of rituximab with the same dosage as approved for the treatment of lymphomas, ie, 375 mg/m2 weekly × 4 weeks. Rituximab is also approved for the treatment of rheumatoid arthritis, with a different dosing regimen: 1000 mg × 2, days 1 and 15.


We aimed to assess the clinical response of patients with pemphigus to a single cycle of rituximab at the dosage used in rheumatoid arthritis. We also evaluated the response to repeated cycles of rituximab.


A total of 47 patients with pemphigus who were treated with rituximab at a dosage of 1000 mg × 2, days 1 and 15, most with concurrent immunosuppressive medications, were retrospectively studied.


Remission rates after the first treatment cycle reached 76%. Repeating the treatment further increased the remission rates to 91%. There was a 22% relapse rate at a median time of 8 months, but 75% of relapsing patients achieved remission again with additional cycles. The side-effect profile was similar to previous reports, except for an immediate postinfusion pemphigus exacerbation in 4 patients.


This was a retrospective study with a limited follow-up period.


The rheumatoid arthritis dosage of rituximab was efficacious and well tolerated in patients with pemphigus. Patients who fail to achieve remission after 1 cycle or patients who relapse seem to benefit from repeated rituximab cycles.

The full text of this article is available in PDF format.

Key words : autoimmune bullous disease, pemphigus, rheumatoid arthritis, rituximab, treatment

Abbreviations used : CR, PCP, PR, RA

 Funding sources: None.
 Conflicts of interest: None declared.

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