Cost and Resource Use of Pemphigus and Pemphigoid Disorders Pre- and Post-Rituximab

Heelan, Kara; Hassan, Shazia; Bannon, G.; Knowles, Sandra R.; Walsh, Scott; Shear, Neil H.; Mittmann, Nicole

doi:10.2310/7750.2014.14092

Cited by 24 publications

(21 citation statements)

References 14 publications

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“…Comparatively, the cost of IVIG is approximately $6000 USD per treatment (1 g/kg, typically 80 g; Canadian Blood Services, personal communication, April 2018). With its potential for durable responses, rituximab has been shown to be less costly due to the need for fewer treatment cycles and its potential to achieve durable remissions …”

Section: Discussionmentioning

confidence: 99%

“…With its potential for durable responses, rituximab has been shown to be less costly due to the need for fewer treatment cycles and its potential to achieve durable remissions. 15,42,43 A unique feature of our study was that we included studies across a range of autoimmune conditions. We only pooled results for randomized trials that defined response criteria and assessed outcomes at the same point in time to ensure methodologic homogeneity.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review of rituximab for autoimmune diseases: a potential alternative to intravenous immune globulin

et al. 2018

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BACKGROUND The anti‐CD20 monoclonal antibody rituximab has immune‐modulatory effects similar to intravenous immunoglobulin (IVIG). We performed a systematic review and meta‐analysis to determine the efficacy and safety of rituximab in autoimmune diseases that are also treated with IVIG. STUDY DESIGN AND METHODS The most common indications for immune modulation with IVIG, as identified from a 2012 regional audit in Canada, were chronic inflammatory demyelinating polyneuropathy (CIDP), immune thrombocytopenia (ITP), myasthenia gravis, multifocal motor neuropathy, Guillain‐Barré syndrome, systemic lupus erythematosus (SLE), Sjogren's syndrome, and pemphigus vulgaris. We searched MEDLINE, EMBASE, and the Cochrane Library until July 2016 for studies evaluating rituximab in each of these conditions. The primary outcome in our meta‐analysis was clinical response at 6 months as defined by disease‐specific criteria in randomized trials. We also calculated pooled proportions of responders within disease types from observational studies. RESULTS Ninety‐five rituximab studies were identified: 86 were observational studies in patients with ITP (n = 1746), SLE (n = 1047), pemphigus vulgaris (n = 564), Sjogren's syndrome (n = 138), myasthenia gravis (n = 66), and CIDP (n = 31) and nine were randomized controlled trials (n = 992) in patients with ITP, SLE, and Sjogren's syndrome that compared rituximab with placebo plus standard of care. Among randomized trials, response rates were higher with rituximab (relative risk, 1.38; 95% confidence interval [CI], 1.05‐1.83). The pooled proportion of rituximab responses ranged from 94% (95% CI, 88%‐98%) for pemphigus vulgaris to 48% (95% CI, 30%‐66%) for CIDP. Rituximab was generally well tolerated in observational studies although in the randomized trials, adverse events were more common in the rituximab group. CONCLUSION Rituximab is an immune‐modulating agent with biologic activity across many autoimmune conditions. Our data support the use of comparative trials with broad eligibility criteria to evaluate rituximab as an alternative to IVIG in autoimmune diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic review of rituximab for autoimmune diseases: a potential alternative to intravenous immune globulin

et al. 2018

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“…[3233] Ahmed and Shetty analyzed the cumulative data on treatment of PV with rituximab and immunosuppressive and found that clinical remission on rituximab therapy was seen in 90%–95% of patients within 6 weeks. Complete resolution was seen in 3–4 months.…”

Section: Rituximabmentioning

confidence: 99%

Shifting focus in the therapeutics of immunobullous disease

Ansari

Sharma

et al. 2017

Indian J Dermatol

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“…Rituximab (a monoclonal antibody directed against CD20, a surface antigen on B lymphocytes) has proven efficacious for the management of pemphigus, including in patients with disease refractory to management with other systemic therapies . Although a single cycle of rituximab has been shown to be effective for induction of remission in pemphigus, there is ongoing controversy over the most appropriate dose and the clinical utility of rituximab is often limited by the high cost of this medication …”

Section: Introductionmentioning

confidence: 99%

Low‐dose rituximab and concurrent adjuvant therapy for pemphigus: Protocol and single‐centre long‐term review of nine patients

Robinson

Unglik

et al. 2017

Aust J Dermatology

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Pemphigus is an autoimmune B-cell mediated blistering disease associated with significant morbidity and mortality. Rituximab has proven effective for the treatment of steroid-refractory pemphigus, although there is controversy over the optimum dosing protocol. Additionally, effective disease control often requires long-term immunosuppression, even in disease-free periods. We present a case series of a single-centre long-term follow up of nine patients with pemphigus, treated with two 500-mg doses of rituximab separated by 14 days along with concurrent adjuvant therapy. In all these patients, low-dose rituximab resulted in B-cell depletion, along with a reduction in blistering disease. Three of these patients required repeat dosing cycles due to either relapsed disease or incomplete disease control following the first dosing cycle, and have remained disease free up to 154 weeks thus far. Six patients developed minor infections during the course of their treatment, but no major complications were observed.

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Cost and Resource Use of Pemphigus and Pemphigoid Disorders Pre- and Post-Rituximab

Abstract: Our findings suggest that RTX is effective in reducing health system resources and the costs associated with the treatment of pemphigus and pemphigoid.

Cited by 24 publications

References 14 publications

Systematic review of rituximab for autoimmune diseases: a potential alternative to intravenous immune globulin

Systematic review of rituximab for autoimmune diseases: a potential alternative to intravenous immune globulin

Shifting focus in the therapeutics of immunobullous disease

Low‐dose rituximab and concurrent adjuvant therapy for pemphigus: Protocol and single‐centre long‐term review of nine patients

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