Abstract
Background: Rituximab induces depletion of B cells and has shown efficacy in antibody-mediated autoimmune disorders. In studies on small series of patients with pemphigus, rituximab administration results in significant improvement. However, differences in inclusion criteria, treatment protocols, and follow-up make it difficult to derive uniform conclusions. Objectives: We sought to test the efficacy and tolerability of rituximab as adjuvant therapy to corticosteroids in the treatment of pemphigus. Methods: In all, 42 patients with pemphigus were treated with rituximab and followed up for up to 5 years. No additional immunosuppressive agents were used. Steroids were rapidly tapered. Outcomes were the proportion of patients who achieved a complete response on or off therapy, the rate of discontinuation of corticosteroid within 6 months, length of remission, time to relapses, and occurrence of adverse events. Results: In all, 36 of 42 patients (86%; 95% confidence interval 75%-96%) achieved a complete response on or off therapy and discontinued steroids within 6 months from induction therapy. Six patients had a complete response off therapy with an additional infusion of rituximab 6 months after initial treatment. Twenty patients experienced a total of 34 relapses; the time to relapse was 8 to 64 months. Every relapse was treated with rituximab (500 mg) without corticosteroids, which induced a new complete response. No serious adverse events were observed. Limitations: Lack of a control group is a limitation. Conclusions: Rituximab therapy induces prolonged clinical remission in patients with pemphigus. Coadministration of other immunosuppressive agents is not necessary. Relapses can be managed with additional infusions administered on demand.
| Original language | English |
|---|---|
| Pages (from-to) | 617-622 |
| Number of pages | 6 |
| Journal | Journal of the American Academy of Dermatology |
| Volume | 67 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Oct 2012 |
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Keywords
- adverse events
- autoimmune bullous diseases
- B cell-depleting treatment
- immunosuppressive treatment
- monoclonal antibodies
- pemphigus
- relapses
- rituximab
- therapy
ASJC Scopus subject areas
- Dermatology
Cite this
Therapy with rituximab for autoimmune pemphigus : Results from a single-center observational study on 42 cases with long-term follow-up. / Cianchini, Giuseppe; Lupi, Francesca; Masini, Cinzia; Corona, Rosamaria; Puddu, Pietro; De Pità, Ornella.
In: Journal of the American Academy of Dermatology, Vol. 67, No. 4, 10.2012, p. 617-622.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Therapy with rituximab for autoimmune pemphigus
T2 - Results from a single-center observational study on 42 cases with long-term follow-up
AU - Cianchini, Giuseppe
AU - Lupi, Francesca
AU - Masini, Cinzia
AU - Corona, Rosamaria
AU - Puddu, Pietro
AU - De Pità, Ornella
PY - 2012/10
Y1 - 2012/10
N2 - Background: Rituximab induces depletion of B cells and has shown efficacy in antibody-mediated autoimmune disorders. In studies on small series of patients with pemphigus, rituximab administration results in significant improvement. However, differences in inclusion criteria, treatment protocols, and follow-up make it difficult to derive uniform conclusions. Objectives: We sought to test the efficacy and tolerability of rituximab as adjuvant therapy to corticosteroids in the treatment of pemphigus. Methods: In all, 42 patients with pemphigus were treated with rituximab and followed up for up to 5 years. No additional immunosuppressive agents were used. Steroids were rapidly tapered. Outcomes were the proportion of patients who achieved a complete response on or off therapy, the rate of discontinuation of corticosteroid within 6 months, length of remission, time to relapses, and occurrence of adverse events. Results: In all, 36 of 42 patients (86%; 95% confidence interval 75%-96%) achieved a complete response on or off therapy and discontinued steroids within 6 months from induction therapy. Six patients had a complete response off therapy with an additional infusion of rituximab 6 months after initial treatment. Twenty patients experienced a total of 34 relapses; the time to relapse was 8 to 64 months. Every relapse was treated with rituximab (500 mg) without corticosteroids, which induced a new complete response. No serious adverse events were observed. Limitations: Lack of a control group is a limitation. Conclusions: Rituximab therapy induces prolonged clinical remission in patients with pemphigus. Coadministration of other immunosuppressive agents is not necessary. Relapses can be managed with additional infusions administered on demand.
AB - Background: Rituximab induces depletion of B cells and has shown efficacy in antibody-mediated autoimmune disorders. In studies on small series of patients with pemphigus, rituximab administration results in significant improvement. However, differences in inclusion criteria, treatment protocols, and follow-up make it difficult to derive uniform conclusions. Objectives: We sought to test the efficacy and tolerability of rituximab as adjuvant therapy to corticosteroids in the treatment of pemphigus. Methods: In all, 42 patients with pemphigus were treated with rituximab and followed up for up to 5 years. No additional immunosuppressive agents were used. Steroids were rapidly tapered. Outcomes were the proportion of patients who achieved a complete response on or off therapy, the rate of discontinuation of corticosteroid within 6 months, length of remission, time to relapses, and occurrence of adverse events. Results: In all, 36 of 42 patients (86%; 95% confidence interval 75%-96%) achieved a complete response on or off therapy and discontinued steroids within 6 months from induction therapy. Six patients had a complete response off therapy with an additional infusion of rituximab 6 months after initial treatment. Twenty patients experienced a total of 34 relapses; the time to relapse was 8 to 64 months. Every relapse was treated with rituximab (500 mg) without corticosteroids, which induced a new complete response. No serious adverse events were observed. Limitations: Lack of a control group is a limitation. Conclusions: Rituximab therapy induces prolonged clinical remission in patients with pemphigus. Coadministration of other immunosuppressive agents is not necessary. Relapses can be managed with additional infusions administered on demand.
KW - adverse events
KW - autoimmune bullous diseases
KW - B cell-depleting treatment
KW - immunosuppressive treatment
KW - monoclonal antibodies
KW - pemphigus
KW - relapses
KW - rituximab
KW - therapy
UR - http://www.scopus.com/inward/record.url?scp=84859980675&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84859980675&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2011.11.007
DO - 10.1016/j.jaad.2011.11.007
M3 - Article
C2 - 22243765
AN - SCOPUS:84859980675
VL - 67
SP - 617
EP - 622
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
SN - 0190-9622
IS - 4
ER -