Infliximab therapy failure in two patients with pemphigus vulgaris

García-Rabasco, A.; Alsina-Gibert, Mercè; Pau-Charles, Ignasi; Iranzo, Pilar

doi:10.1016/j.jaad.2011.05.029

Cited by 17 publications

(10 citation statements)

References 4 publications

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“…TNF‐α inhibitors have shown variable success in the treatment for PV based on small treatment groups. Etanercept and infliximab were successful in the treatment of a handful of PV patients . On the contrary, a case report noted the spontaneous development of PV in a psoriatic patient upon treatment with infliximab .…”

Section: Therapeutic Targets In the Pv Pathogenesismentioning

confidence: 99%

Autoreactive T cells in the immune pathogenesis of pemphigus vulgaris

Amber

Staropoli

Shiman

et al. 2013

Experimental Dermatology

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Pemphigus vulgaris is a life-threatening autoimmune blistering disease caused by anti-desmoglein IgG autoantibodies that finally lead to acantholysis presenting clinically as progressive blistering. Whilst the production of pathogenic antibodies is key to the development of pemphigus vulgaris, many immunological steps are required prior to autoantibody induction. We review advances in the understanding of these immunologic processes with a focus on human leucocyte antigen polymorphisms and antigen recognition, epitope spreading, central and peripheral tolerance, T helper differentiation, induction of pro-and antiinflammatory cytokines and T-cell regulation of B cells. Targeting autoaggressive T cells as regulators and stimulators of B-cell antibody production should allow for more specific therapeutic immune interventions, avoiding the global immunosuppression seen with many commonly used immunosuppressants in pemphigus vulgaris.

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Section: Therapeutic Targets In the Pv Pathogenesismentioning

confidence: 99%

Autoreactive T cells in the immune pathogenesis of pemphigus vulgaris

Amber

Staropoli

Shiman

et al. 2013

Experimental Dermatology

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“… 50 , 51 On the other hand, there are also several case series and a small comparative study showing no benefit in patients with PV treated with infliximab. 52 , 53 There is also one case of a patient treated with infliximab for rheumatoid arthritis who developed pemphigus foliaceus. 54 In the context of current evidence, infliximab does not have a role in the treatment of PV.…”

Section: Treatment Agentsmentioning

confidence: 99%

Management of pemphigus vulgaris: challenges and solutions

Gregoriou¹,

Efthymiou²,

Stefanaki³

et al. 2015

CCID

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The main objective in the treatment of pemphigus vulgaris is to control the disease, prevent relapses, and avoid adverse events associated with the prolonged use of steroids and immunosuppressive agents. Systemic corticosteroids remain the gold standard treatment for pemphigus vulgaris. Azathioprine and mycophenolate mofetil are the first line of steroid-sparing treatment. Rituximab is extremely effective in recalcitrant pemphigus, when other treatments fail to control the disease. The European Dermatology Forum recommends tapering prednisolone by 25% every 2 weeks after the consolidation phase, and a 5 mg reduction every 4 weeks when the dose is reduced to <20 mg. If the patient relapses, options include increasing steroids back to the previous dose, adding an immunosuppressant if using steroid monotherapy, or replacing a first-line immunosuppressant by another if already on combination therapy.

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“…In the second patient, when infliximab was given along with a prednisone dose of 20 mg/day, the patient did not develop new lesions and previous lesions began to heal. However, any time the dose of prednisone was decreased below 10 mg/day, the patient experienced a severe flare of her mucocutaneous lesions and infliximab was terminated after 7 infusions due to lack of response [36]. While this study fails to support the efficacy of infliximab in the treatment of PV, the evidence may be limited by the severity of the patients' disease.…”

Section: Anti-tumor Necrosis Factor (Tnf) Agentsmentioning

confidence: 76%

Pemphigus vulgaris: approach to treatment

Sinha¹,

Hoffman²,

Janicke³

2015

European Journal of Dermatology

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The therapeutic management of pemphigus vulgaris (PV) is centered around immunosuppression, which can be generalized, as in the use of corticosteroids or steroid sparing agents, or specific, as in therapeutic blockage of autoantibody production, certain cytokines, or signaling pathways. Currently, the backbone of treatment for PV, particularly, first line therapy, remains systemic corticosteroids. Although very effective, the significant side effects of long-term corticosteroid usage are well documented. Adjunctive therapies aim to eliminate, or at least decrease, the necessary dose of corticosteroids. Specifically, azathioprine, cyclophosphamide, methotrexate, cyclosporine, mycophenolate mofetil and dapsone are now widely used in PV. Intravenous immunoglobulin (IVIG), plasmapheresis, immunoadsorption, and most recently, rituximab, are other members of the therapeutic armamentarium. However, despite the widening range of treatment options in PV, well-controlled clinical trials and consensus guidelines are lacking.

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Infliximab therapy failure in two patients with pemphigus vulgaris

Cited by 17 publications

References 4 publications

Autoreactive T cells in the immune pathogenesis of pemphigus vulgaris

Autoreactive T cells in the immune pathogenesis of pemphigus vulgaris

Management of pemphigus vulgaris: challenges and solutions

Pemphigus vulgaris: approach to treatment

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