title: A prospective study on clinical response and cell-mediated immunity of pemphigus patients treated with rituximab.
abstract: Rituximab has recently been reported in retrospective studies to be effective in pemphigus at the dosing schedule used for treating rheumatoid arthritis (RA) of two 1,000 mg infusions 2 weeks apart. While the effect of rituximab on B cells has been well described, its effect on global T cell function has not been assessed. Ten patients who received RA dosage rituximab were prospectively assessed for clinical response. Immunological response including autoantibody titers, CD20+ B cell, and CD4+ T cell counts was assessed pre- and post-treatment. The CD4+ T cell function was determined by a novel assay measuring intracellular ATP levels in response to mitogenic stimulus. At 6 months, 90 % of patients achieved remission. Disease control and remission were achieved at median times of 1 and 3.7 months, respectively. There was a 67 % relapse rate during an average follow-up of 22 months. Global CD4+ T cell numbers and function were preserved 3 months after rituximab. A single cycle of RA dosage rituximab with concomitant immunosuppression is effective in pemphigus. We did not find an effect on total CD4+ T cell numbers or function 3 months after treatment.
authors.affiliation: Department of Dermatology, Rabin Medical Center, Beilinson Hospital, 49100, Petach Tikva, Israel, yael.leshem@gmail.com.
authors.forename: Y A
authors.initials: YA
authors.lastname: Leshem
authors.forename: M
authors.initials: M
authors.lastname: David
authors.forename: E
authors.initials: E
authors.lastname: Hodak
authors.forename: D A
authors.initials: DA
authors.lastname: Waitman
authors.forename: D
authors.initials: D
authors.lastname: Vardy
authors.forename: M
authors.initials: M
authors.lastname: Israeli
authors.forename: M
authors.initials: M
authors.lastname: Eskin-Schwartz
authors.forename: R
authors.initials: R
authors.lastname: Bergman
authors.forename: D
authors.initials: D
authors.lastname: Mimouni
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018951:Antigens, CD20 / Q000097:blood; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D001402:B-Lymphocytes / Q000276:immunology*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000188:drug therapy*; D011446:Prospective Studies; D012008:Recurrence; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D001323:Autoantibodies; D000069283:Rituximab