Clinical efficacy of rituximab in the treatment of pemphigus: A retrospective study.
BACKGROUND
Pulsed corticosteroids have been used successfully for the management of pemphigus. However, prolonged use of glucocorticoids may be associated with adverse effects and some patients show a poor response to conventional therapy. Biologics have shown a promising role in such cases; however, there is limited data from the Indian subcontinent.


OBJECTIVE
The primary objective was to assess the efficacy and adverse effects of rituximab in pemphigus. The secondary objective was to measure the cumulative doses of corticosteroids required for these patients.


METHODS
We undertook a retrospective review of records of 25 pemphigus patients (pemphigus vulgaris: 21, pemphigus foliaceus: 4) who had received rituximab infusion (rheumatoid arthritis protocol in 21 patients, modified in 4). Oral prednisolone was administered in dosages up to 0.5 mg/kg of body weight and tapered over the next 3-4 months according to the disease activity. However, other immunosuppressive agents such as cyclophosphamide and azathioprine were continued for one year after clinical remission was achieved.


RESULTS
Complete remission was observed in 22 (88%) patients. The mean time to disease control and complete remission was 1.10 and 4.36 months, respectively. Four (16%) patients experienced relapse after a mean duration of 11.75 months. The mean total dose of oral steroids administered was equivalent to 3535.64 mg of prednisolone. Exacerbation of disease was noted in two patients after the first dose of rituximab and infectious complications, pneumonia and cellulitis, developed in one patient each.


CONCLUSIONS
A small sample size, the retrospective nature of the study and unavailability of follow-up anti-desmoglein autoantibodies levels were limitations.


CONCLUSIONS
Rituximab is an effective agent in the treatment of pemphigus. The use of rituximab enabled use of a lower initial dose of oral prednisolone in pemphigus and hence reduced its total cumulative dose. Severe side effects were rare.
Department of Dermatology and Venereology, All Institute of Medical Sciences, New Delhi, India.
Vinod Kumar
VK
Sharma
Department of Dermatology and Venereology, All Institute of Medical Sciences, New Delhi, India.
Neetu
N
Bhari
Department of Dermatology and Venereology, All Institute of Medical Sciences, New Delhi, India.
Somesh
S
Gupta
Department of Dermatology and Venereology, All Institute of Medical Sciences, New Delhi, India.
Kanika
K
Sahni
Department of Dermatology and Venereology, All Institute of Medical Sciences, New Delhi, India.
Neena
N
Khanna
Department of Dermatology and Venereology, All Institute of Medical Sciences, New Delhi, India.
M
M
Ramam
Department of Dermatology and Venereology, All Institute of Medical Sciences, New Delhi, India.
G
G
Sethuraman
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000175:diagnosis* / Q000188:drug therapy*; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
D007155:Immunologic Factors; D000069283:Rituximab