Rituximab in the treatment of ocular cicatricial pemphigoid: a retrospective cohort study

You, Caiyun; Lamba, Neerav; Lasave, Andrés F.; Ma, Lina; Díaz, Mikhail Hernández; Foster, C. Stephen

doi:10.1007/s00417-017-3603-3

Cited by 40 publications

(24 citation statements)

References 18 publications

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“…In order to assess the correlation between the MMP‐involved site and the response to RTX, we conducted a review of the literature. Using the search terms ‘MMP’ and ‘rituximab’ in the PubMed database, we found 30 articles 5–34 (detailed in Table ) covering 167 patients with MMP treated with RTX. Their demographic and therapeutic characteristics are shown in the supplementary material (Tables and , respectively).…”

Section: Reportmentioning

confidence: 99%

Laryngeal mucous membrane pemphigoid serves as a prognostic factor for poor response to treatment with rituximab

et al. 2021

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Summary Mucous membrane pemphigoid (MMP) is an autoimmune blistering, scarring and occasionally mutilating disease that may progress to blindness or airway obstruction. Over the past few years, rituximab (RTX) has emerged as a potential therapeutic solution for MMP; however, the literature regarding its efficacy in the treatment of severe MMP is sparse. We studied four patients with recalcitrant MMP who were treated with RTX. Three of these had recalcitrant laryngeal disease; two were unresponsive to RTX, while the third patient achieved complete remission (CR) but relapsed twice. The fourth patient, who had oral and ocular disease, also achieved CR. In addition, we reviewed 143 cases of MMP treated with RTX reported in the literature to date. Of these, 120 had late observation endpoints, of whom 81 (67.5%) achieved CR, 24 (20%) received partial remission and 15 (12.5%) had no remission. Based on this study, the presence of laryngeal MMP seems to predict refractoriness to RTX treatment. In conclusion, we found that RTX can ameliorate the MMP course and that laryngeal involvement, which is known to be a prognostic factor for severe MMP, may also predict poor response to RTX.

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Section: Reportmentioning

confidence: 99%

Laryngeal mucous membrane pemphigoid serves as a prognostic factor for poor response to treatment with rituximab

et al. 2021

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“…In a retrospective cohort, mucous membrane pemphigoid ( n = 14) exhibited disease control in 85.7% (partial response: 64.3%, complete response: 28.6%) (67). Similarly, some encouraging data have been obtained in ocular cicatricial pemphigoid (68). A meta-analysis showed that rituximab is also a promising option in epidermolysis bullosa acquisita (69).…”

Section: Bullous Disorders: Bullous Pemphigoid (Bp) and Other Bullousmentioning

confidence: 83%

Learning From Success and Failure: Biologics for Non-approved Skin Diseases

2019

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The impressive potential of biologics has been demonstrated in psoriasis, hidradenitis suppurativa, and urticaria. Numerous biologicals are entering the field for a restricted number of skin disorders. Off-label use of biologics in other recalcitrant skin diseases has increased. Mounting data point to the potential of already existing biologics acting on the IL-17/IL-23 pathway in skin disorders with epidermal hyperkeratosis (e.g., pityriasis rubra pilaris), acneiform inflammation (e.g., hidradenitis suppurativa), and loss of mucosal integrity (e.g., aphthosis). TNF-α blockers are also effective in the latter conditions but seem of particular value in granulomatous (e.g., granuloma annulare) and neutrophilic disorders (e.g., pyoderma gangrenosum). Failure of IL-17 blockade in skin diseases resulting from immune-mediated cell destruction (e.g., alopecia areata and vitiligo) illustrates its limited involvement in Th1-dependent skin immunology. Overall, disappointing results of TNF-α blockers in alopecia areata and vitiligo point to the same conclusion although promising results in toxic epidermal necrolysis suggest TNF-α exerts at least some in vivo Th1-related activities. Acting on both the Th1 and Th17 pathway, ustekinumab has a rather broad potential with interesting results in lupus and alopecia areata. The efficacy of omalizumab in bullous pemphigoid has revealed an IgE-mediated recruitment of eosinophils leading to bullae formation. Reconsidering reimbursement criteria for less common but severe diseases seems appropriate if substantial evidence is available (e.g., pityriasis rubra pilaris). For other disorders, investigator-and industry-initiated randomized clinical trials should be stimulated. They are likely to improve patient outcome and advance our understanding of challenging skin disorders.

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“…The progression of ocular involvement was controlled and no cicatrization developed in the follow-up. Adverse effects were mild and transient [111].…”

Section: Therapy Of Mucous Membrane Pemphigoid (Cicatricial Pemphigoid)mentioning

confidence: 94%

Current Therapy in Autoimmune Bullous Diseases

Svecova¹

2018

Autoimmune Bullous Diseases

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The goal of the treatment of autoimmune bullous disease is to reduce the production of pathogenic autoantibodies or increase elimination of pathogenic autoantibodies from serum of the patients. Immunosuppressive therapy reduces the production of autoantibodies. The therapy protocol is divided into three phases. The first is a control phase with the highest dose of immunosuppressive drugs suppressing activity of disease, followed with a consolidation phase, when the bulk of lesions is healed. The last phase is a maintenance phase when immunosuppressive medication is gradually tapered to the lowest level that suppresses the appearance of new lesions. In complete remission off therapy, the patient reached complete clinical remission and does not use any immunosuppressive medication. In complete remission on therapy, the patient uses a minimal immunosuppressive therapy. The first-line treatment is corticosteroids in pemphigus and pemphigoid groups. Adjuvant immunosuppressive drugs are combined with systemic corticosteroids and display a corticosteroid sparing effect. First-line immunosuppressive adjuvants comprise azathioprine, mycophenolate mofetil and mycophenolic acid. Rituximab, intravenous immunoglobulin G, immunoadsorption, cyclophosphamide, dapsone, and methotrexate are regarded as the second-line adjuvants. In dermatitis herpetiformis, a gluten free diet eliminates the clinical symptoms. Dapsone is regarded to be a valid therapeutic option in management of dermatitis herpetiformis.

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Rituximab in the treatment of ocular cicatricial pemphigoid: a retrospective cohort study

Abstract: These retrospective data suggest that RTX is efficacious and well tolerated when included for the treatment of OCP. Controlled studies are necessary to identify the role of this IMT agent in the therapeutic arsenal, especially its optimum dose and duration of administration.

Cited by 40 publications

References 18 publications

Laryngeal mucous membrane pemphigoid serves as a prognostic factor for poor response to treatment with rituximab

Laryngeal mucous membrane pemphigoid serves as a prognostic factor for poor response to treatment with rituximab

Learning From Success and Failure: Biologics for Non-approved Skin Diseases

Current Therapy in Autoimmune Bullous Diseases

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