Efficacy and safety of rituximab treatment in Indian pemphigus patients

Kanwar, Amrinder J.; Tsuruta, Daisuke; Vinay, Keshavamurthy; Koga, Hiroshi; Ishii, Norito; Dainichi, Teruki; Hashimoto, Takashi

doi:10.1111/j.1468-3083.2011.04391.x

Cited by 58 publications

(82 citation statements)

References 33 publications

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“…The association between shorter disease duration and higher rate of CR might support the rationale for using RTX as a first-line treatment in pemphigus, even for treatment-naïve patients (12,19,24,31,39). Lunardon et al (12) also suggested that treatment with RTX earlier in the course of disease might result in better outcomes.…”

Section: Discussionmentioning

confidence: 93%

“…However, there is no universally accepted protocol for its use in pemphigus. Several commonly used regimens include a lymphoma protocol (4 weekly infusions of RTX at a dose of 375 mg/m 2 ) (4-17), a rheumatoid arthritis (RA) protocol (2×1,000 mg doses of RTX at a 2-week interval) (10,12,(18)(19)(20)(21), low-dose RTX (2×500 mg doses of RTX at a 2-week interval) (10,16,(21)(22)(23)(24) with or without concomitant use of IA (9,10,(25)(26)(27)(28)(29) or IVIG (30). RTX has also been used as a first-line treatment with favourable outcomes (12,31).…”

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confidence: 99%

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Efficacy of Rituximab for Pemphigus: A Systematic Review and Meta-analysis of Different Regimens

et al. 2015

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This meta-analysis examined the efficacy of different dosing regimens containing rituximab (RTX) in treating pemphigus. The analysis included 578 patients with pemphigus from 30 studies. Seventy-six percent of patients achieved complete remission (CR) after 1 cycle of RTX. Mean time to remission was 5.8 months, with a remission duration of 14.5 months and a 40% relapse rate. Eighteen patients (3.3%) developed serious adverse effects. The pooled estimate showed no significant differences in CR and relapse rates between patients treated with high-dose (near or ≥ 2,000 mg/cycle) vs. low-dose (< 1,500 mg/cycle) RTX. In the fully adjusted analysis, high-dose RTX was associated with longer duration of CR compared with low-dose RTX. No superiority of lymphoma protocol over rheumatoid arthritis or high-dose RTX over low-dose RTX was shown in other outcomes. RTX treatment is efficacious and well-tolerated in treating pemphigus. High-dose RTX treatment may lead to longer duration of remission. However, the choice of optimal regimen depends on the overall condition of the individual patient.

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Section: Discussionmentioning

confidence: 93%

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confidence: 99%

Efficacy of Rituximab for Pemphigus: A Systematic Review and Meta-analysis of Different Regimens

et al. 2015

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“…Relapse rates in the literature range between 0 and 53% [10,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32]. Three studies using the 1,000 mg biweekly regimen report lower relapse rates (0-22%) [28,30,32]. A randomized study could verify whether there is indeed superiority of the biweekly regimen in relapse rates.…”

Section: Discussionmentioning

confidence: 99%

“…The beneficial effect of rituximab in pemphigus vulgaris was initially described in 2002, and since then several studies have been presented in the literature [10,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32] (table 2). In 95% of patients treated, at least partial remission is achieved as summarized in a meta-analysis by Schmidt et al [33].…”

Section: Discussionmentioning

confidence: 99%

Pilot Study of 19 Patients with Severe Pemphigus: Prophylactic Treatment with Rituximab Does Not Appear to be Beneficial

Gregoriou

Giatrakou²,

Θεοδωρόπουλος³

et al. 2014

Dermatology

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Aims: To assess the efficacy and safety of rituximab in refractory pemphigus and the possible benefit of an additional prophylactic infusion at 6 months. Methods: Seventeen patients with pemphigus vulgaris, 1 with pemphigus foliaceus and 1 with pemphigus vegetans were treated with 4 weekly infusions of rituximab (375 mg/m²). Nine patients received an additional prophylactic infusion after 6 months while the rest received no maintenance therapy. In case of recurrence, an additional single infusion was administered. Results: Control of the disease was obtained after 3-8 weeks. End of the consolidation phase for all patients was observed after 16 weeks. Patients remained in full remission for 7-42 months. All immunosuppressive agents, including prednisone, were discontinued after 2-12 months. The disease relapsed in 5 out of 9 patients who received the additional prophylactic infusion, and in 3 out of 10 patients among those skipping the prophylactic additional infusion. Conclusion: One course of rituximab and treatment of relapses is highly effective and well tolerated in the treatment of refractory pemphigus. In this pilot study of 19 patients, the prophylactic infusion does not appear to have provided any additional benefit to the patients receiving it.

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“…The mean TDC in various earlier studies using rituximab with concomitant oral corticosteroids ranged from 6 to 8 weeks [14,15] .…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Effects of Rituximab Monotherapy on Different Subsets of Circulating T-Regulatory Cells and Clinical Disease Severity in Severe Pemphigus Vulgaris

Bhattacharjee

Handa

et al. 2016

Dermatology

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Background: Robust evidence for the efficacy of rituximab monotherapy in pemphigus is lacking. The effects of rituximab on T-regulatory cells (Tregs) in pemphigus have not been studied. Objective: The primary objective was to assess the efficacy of rituximab monotherapy in severe pemphigus vulgaris. The secondary objectives were to assess whether counts of different subsets of Tregs in the peripheral blood correlate with baseline clinical severity and whether clinical response in severe pemphigus is associated with an alteration in the Treg count. Methods: Eighteen eligible subjects with severe pemphigus vulgaris were recruited and were treated with 1 g of intravenous rituximab on days 0 and 15. Efficacy was assessed in terms of disease control, time to disease control, complete remission off therapy, and relapse. Flow cytometric analysis of CD4+CD25+FoxP3, IL-10-secreting Tr1, and TGF-β secreting Th3 regulatory cells was performed. Clinical evaluation and flow cytometric analysis of Tregs was performed periodically until follow-up at 26 weeks. Results: Rituximab monotherapy was able to induce complete remission in all but 5 (68.75%) patients and was well tolerated. No direct relationship between clinical severity and CD4+CD25+FoxP3 cell counts was found. There were inverse correlations between serially measured values of the cutaneous and mucosal Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Th3 cell count. Conclusion: Rituximab is a safe and effective monotherapy option for severe pemphigus. As the immunological findings were somewhat different from those observed in other autoimmune conditions treated with rituximab, further studies are required to substantiate the findings of our study in pemphigus patients.

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Efficacy and safety of rituximab treatment in Indian pemphigus patients

Abstract: Rituximab is effective in treating resistant and severe pemphigus in Indian patients. Acute complications can occur during rituximab infusion and require close monitoring.

Cited by 58 publications

References 33 publications

Efficacy of Rituximab for Pemphigus: A Systematic Review and Meta-analysis of Different Regimens

Efficacy of Rituximab for Pemphigus: A Systematic Review and Meta-analysis of Different Regimens

Pilot Study of 19 Patients with Severe Pemphigus: Prophylactic Treatment with Rituximab Does Not Appear to be Beneficial

Assessment of the Effects of Rituximab Monotherapy on Different Subsets of Circulating T-Regulatory Cells and Clinical Disease Severity in Severe Pemphigus Vulgaris

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