Adjuvant rituximab therapy of pemphigus a single-center experience with 31 patients

Luisa Lunardon, Kathleen J. Tsai, Kathleen J. Propert, Nicole Fett, John R. Stanley, Victoria P. Werth, Donald E. Tsai, Aimee S. Payne

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Background: We conducted a retrospective study of patients with pemphigus vulgaris (n=24) and foliaceus (n=7) treated with adjuvant rituximab to determine efficacy and adverse events. The end point for efficacy was complete remission of disease taking no or minimal therapy. Observations: Eighteen patients (58%) achieved the study end point. Of these, 13 patients achieved complete remission off systemic therapy. Patients achieving the study end point had a median disease duration before rituximab therapy of 19 months vs 86 months in those not achieving the end point (P=.01). For the 18 patients achieving the end point, the median (SD) duration of remission was 19 (2) months. Eight of these 18 patients (44%) relapsed from 6 to 17 months after treatment. Serious adverse events attributed to rituximab treatment (osteomyelitis or phlegmon) occurred in 2 patients (6%). In paired serum samples from 10 patients before and after rituximab treatment, the percent change in serum desmoglein index value (median, -80%) was unrelated to the percent change in pneumococcal antibodies (median, +8%) (Spearman rank correlation coefficient r=-0.2). Conclusions: Patients treated with rituximab earlier in the course of disease may have better outcomes. A discussion of rituximab's mechanism of action supports the rationale for early therapy. Prospective clinical studies are necessary to substantiate this observation.

Original languageEnglish (US)
Pages (from-to)1031-1036
Number of pages6
JournalArchives of dermatology
Issue number9
StatePublished - Sep 2012

ASJC Scopus subject areas

  • Dermatology

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    Lunardon, L., Tsai, K. J., Propert, K. J., Fett, N., Stanley, J. R., Werth, V. P., Tsai, D. E., & Payne, A. S. (2012). Adjuvant rituximab therapy of pemphigus a single-center experience with 31 patients. Archives of dermatology, 148(9), 1031-1036.