Clinical experiences of different dosing schedules of rituximab in pemphigus with various disease severities.
BACKGROUND
Rituximab, a monoclonal antibody directed against B lymphocytes, has been found to be a therapeutic agent for severe, refractory autoimmune bullous diseases. However, a dosing schedule or treatment indication of rituximab has not yet been established.


OBJECTIVE
We investigated the efficacy of rituximab and different dosing schedules for different disease severities, retrospectively.


METHODS
A total of 23 patients with pemphigus who received rituximab were evaluated by a review of medical records. Group 1 patients (n = 10) with severe pemphigus were treated with three or four infusions of rituximab at a dose of 375 mg/m(2) at 1-week intervals. Group 2 (n = 13) patients with mild to moderate pemphigus were treated with two infusions of rituximab at the same dose. Late end points, occurrence of relapse and adverse events and numbers of B cells were evaluated.


RESULTS
The mean follow-up period was 25.6 months in group 1 and 17.8 months in group 2. In group 1, six patients (60.0%) achieved complete remission (CR), including two patients off therapy (CR OFF) and four patients on therapy (CR ON). The other four patients (40.0%) achieved partial remission on therapy (PR ON). In group 2, nine patients (69.2%) achieved CR (4 CR OFF, 5 CR ON) and four patients (30.8%) achieved PR ON. During the follow-up period, relapse occurred in five patients of group 1 and three patients of group 2. No serious adverse events were observed in any patients.


CONCLUSIONS
We concluded that rituximab is an effective and safe treatment method not only in severe, recalcitrant pemphigus but also in mild to moderate pemphigus. Low dose of rituximab seemed to be sufficient to treat mild to moderate pemphigus.
Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea.
H H
HH
Cho
Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea.
S-P
SP
Jin
Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea.
J H
JH
Chung
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage* / Q000009:adverse effects; D001402:B-Lymphocytes; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000188:drug therapy*; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab; D012720:Severity of Illness Index; D016896:Treatment Outcome
D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab