title: Rituximab for treatment-refractory pemphigus and pemphigoid: a case series of 17 patients.
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/m(2) 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.
  
  
  CONCLUSIONS
  Rituximab has been combined with various other immunosuppressive or immunomodulatory treatments.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, University of Lübeck, Lübeck, Germany. Electronic address: Michael.Kasperkiewicz@uk-sh.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Kasperkiewicz
authors.affiliation: Department of Dermatology, University of Lübeck, Lübeck, Germany.
authors.forename: Iakov
authors.initials: I
authors.lastname: Shimanovich
authors.affiliation: Department of Dermatology, University of Lübeck, Lübeck, Germany.
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Ludwig
authors.affiliation: Department of Dermatology, University of Lübeck, Lübeck, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rose
authors.affiliation: Department of Dermatology, University of Lübeck, Lübeck, Germany.
authors.forename: Detlef
authors.initials: D
authors.lastname: Zillikens
authors.affiliation: Department of Dermatology, University of Lübeck, Lübeck, Germany; Comprehensive Center for Inflammatory Medicine, University of Lübeck, Lübeck, Germany.
authors.forename: Enno
authors.initials: E
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000188:drug therapy*; D010392:Pemphigus / Q000188:drug therapy*; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab