Recommendations for the use of rituximab (anti-CD20 antibody) in the treatment of autoimmune bullous skin diseases.
Autoimmune bullous skin disorders are induced by autoantibodies against distinct adhesion complexes of the epidermal and dermal-epidermal junction. Since most of these disorders are characterized by a severe, potentially lethal course,they require long-term immunosuppressive treatment to reduce the de novo synthesis of pathogenic autoantibodies by B lymphocytes. Rituximab, a chimeric monoclonal antibody against CD20 on B lymphocytes, has shown promise in several case reports or cohort studies in the treatment of paraneo-plastic pemphigus,refractory cases of pemphigus vulgaris and foliaceus and in other autoimmune bullous disorders. Treatment with rituximab leads to depletion of pathogenic B-cells which may last up to 12 months resulting in a reduction of plasma cells secreting pathogenic autoantibodies. Rituximab is usually administered in an adjuvant setting at a dose of 375 mg/m(2) i.v.in weekly intervals for four consecutive weeks in addition to the standard immunosuppressive treatment. The present consensus statement of German-speaking dermatologists, rheumatologists and oncologists summarizes and evaluates the current evidence for the use and mode of application of rituximab in autoimmune bullous skin disorders.
Hertl
Michael
M
Department of Dermatology and Allergology, University Clinic of Giessen and Marburg GmbH, Marburg, Germany. hertl@med.uni-marburg.de
Zillikens
Detlef
D
Borradori
Luca
L
Bruckner-Tuderman
Leena
L
Burckhard
Harald
H
Eming
Rüdiger
R
Engert
Andreas
A
Goebeler
Matthias
M
Hofmann
Silke
S
Hunzelmann
Nicolas
N
Karlhofer
Franz
F
Kautz
Ocko
O
Lippert
Undine
U
Niedermeier
Andrea
A
Nitschke
Martin
M
Pfütze
Martin
M
Reiser
Marcel
M
Rose
Christian
C
Schmidt
Enno
E
Shimanovich
Iakov
I
Sticherling
Michael
M
Wolff-Franke
Sonja
S
D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D001327:Autoimmune Diseases / Q000188:drug therapy*; D003880:Dermatology / Q000592:standards*; D004334:Drug Administration Schedule; D006801:Humans; D017410:Practice Guidelines as Topic; D000069283:Rituximab; D012872:Skin Diseases, Vesiculobullous / Q000188:drug therapy*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab