Bullous and mucous membrane pemphigoid show a mixed response to rituximab: experience in seven patients

Lourari, S.; Hervé, Caroline; Doffoël-Hantz, V.; Meyer, Nicolás; Livideanu, Cristina Bulai; Viraben, R.; Maza, A.; Adoue, D.; Bédane, Christophe; Paul, C.

doi:10.1111/j.1468-3083.2010.03889.x

Cited by 59 publications

(30 citation statements)

References 10 publications

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“…The long-term side effects of rituximab in patients with PV are not yet known. Rituximab can result in cardiac side effects [77, 78]. Patients and their families should be advised of these facts.…”

Section: Discussionmentioning

confidence: 99%

Rituximab in the Treatment of Pemphigus Vulgaris

Zakka

Shetty

Ahmed

2012

Dermatol Ther (Heidelb)

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IntroductionRituximab is increasingly used in patients with pemphigus vulgaris (PV) who are nonresponders to conventional therapy.MethodsA PubMed search was conducted using the words pemphigus vulgaris and rituximab therapy from papers published between 2000 and 2012. Two protocols were used. In the lymphoma protocol, patients received four weekly infusions of rituximab (dose 375 mg/m2). The rheumatoid arthritis (RA) protocol consisted of two infusions of 1,000 mg each 15 days apart. The variables recorded from each study included clinical remission off or on therapy, relapse rate, incidence of serious adverse events, concomitant therapies, duration of follow-up, and when available, levels of B cells and autoantibodies.ResultsForty-two studies were found, which reported 272 patients; 180 were treated by the lymphoma protocol and 92 by the RA protocol. Both protocols were effective in treating recalcitrant PV. The lymphoma protocol had a lower response rate, relapse rate and serious infections, but higher mortality, and there were nonresponders. The RA protocol produced a higher response rate, relapse rate, number of infections, but lower mortality rate, and lacked nonresponders. The cumulative follow-up for patients treated with the lymphoma protocol was 15.44 months (range 1–41) and 21.04 months (range 8.35–29) for the RA protocol. A major concern in both protocols was the high infection rates, some of which were fatal. A different protocol using a combination of rituximab with intravenous immunoglobulin in a defined manner with a definitive endpoint, used in a limited cohort of patients, showed promising results.ConclusionNeither protocol produced a sustained clinical remission and both required continued systemic therapy. Before initiation of treatment, physicians should have a specific goal and endpoint and be aware of its potential side effects and lack of information on its long-term effects. Patients should be carefully monitored during and after therapy.

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Section: Discussionmentioning

confidence: 99%

Rituximab in the Treatment of Pemphigus Vulgaris

Zakka

Shetty

Ahmed

2012

Dermatol Ther (Heidelb)

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“…However, because not all patients respond to these treatments, B cell depletion therapy using Rituximab (with a view to targeting autoreactive B cells) has been evaluated in a limited number of patients. Treatment of immunobullous disorders including pemphigus and bullous pemphigoid with Rituximab resulted in improvement of skin lesions, and has been reported to be associated with a reduction in titers of circulating autoantibodies in some patients, and this was attributed to the systemic depletion of mature CD20 + B cells [75][76][77][78][79][80][81].…”

Section: Reviewmentioning

confidence: 99%

Revisiting the role of B cells in skin immune surveillance

Egbuniwe

Karagiannis

Nestle

et al. 2015

Trends in Immunology

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Whereas our understanding of the skin immune system has increased exponentially in recent years, the role of B cells in cutaneous immunity remains poorly defined. Recent studies have revealed the presence of B cells within lymphocytic infiltrates in chronic inflammatory skin diseases and cutaneous malignancies including melanoma, and have examined their functional significance in these settings. We review these findings and discuss them in the context of the current understanding of the role of B cells in normal skin physiology, as well as in both animal and human models of skin pathology. We integrate these findings into a model of cutaneous immunity wherein crosstalk between B cells and other skin-resident immune cells plays a central role in skin immune homeostasis.

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“…To these existing reports, an additional 5 cases were added, in which 3 patients experienced complete remission, 1 partial remission, and 1 patient died. 73 …”

Section: Bullous Pemphigoidmentioning

confidence: 99%

Treatment of subepidermal immunobullous diseases

Culton

Díaz

2012

Clinics in Dermatology

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The subepidermal immunobullous diseases are a group of autoimmune blistering disorders of the skin and mucous membranes that share the common features of autoantibody deposition and blister formation at the dermal-epidermal junction or basement membrane. This group includes bullous pemphigoid, linear IgA disease, dermatitis herpetiformis, and epidermolysis bullosa acquisita, among others. Although these disorders share some common features, each disease is unique in its clinical presentation, histopathology, and immunofluorescence patterns, which allows for accurate diagnosis and disease-specific treatment strategy. Treatment of these disorders is complex and requires expert knowledge of disease pathogenesis. We review common treatment approaches for each of these disorders.

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Bullous and mucous membrane pemphigoid show a mixed response to rituximab: experience in seven patients

Cited by 59 publications

References 10 publications

Rituximab in the Treatment of Pemphigus Vulgaris

Rituximab in the Treatment of Pemphigus Vulgaris

Revisiting the role of B cells in skin immune surveillance

Treatment of subepidermal immunobullous diseases

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