Rituximab versus Mycophenolate Mofetil in Patients with Pemphigus Vulgaris

Werth, Victoria P.; Joly, P.; Mimouni, Daniel; Maverakis, Emanual; Caux, F.; Lehane, Patricia B.; Gearhart, L.; Kapre, Audrey; Pordeli, Pooneh; Chen, Diana M.

doi:10.1056/nejmoa2028564

Cited by 82 publications

(91 citation statements)

References 14 publications

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“…It was found that the number of flares and the total cumulative steroid doses were higher in the MMF group. However, serious adverse reactions occurred in 22% of the patients in the RTX group compared with 15% of the patients in the MMF group 9 . In our study, none of the patients who received azathioprine or MMF experienced adverse effects.…”

Section: Discussioncontrasting

confidence: 58%

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Pemphigus vulgaris relapse during the coronavirus disease pandemic

Saleh

2022

Dermatologic Therapy

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Pemphigus vulgaris (PV) is the most common type of pemphigus group of autoimmune skin diseases. The treatment of PV relapse is challenging especially during the coronavirus disease (COVID-19) pandemic. In this prospective study, we aimed to evaluate the treatment of patients with relapsing PV during the pandemic.Twelve patients with PV who experienced relapse from March 2020 to January 2022 were included. The patients were asked whether they experienced COVID-19 symptoms and the pemphigus disease area index (PDAI) was measured. PCR for COVID-19, chest computed tomography, routine investigations, and electrocardiography were performed for the admitted patients. The mean PDAI of the patients during relapse was 23.6 ± 14.8 (range 5-60). Seven patients received azathioprine; one patient received mycophenolate mofetil; and six patients received 1000 mg of rituximab (RTX) twice at an interval of 14 days. None of the 12 patients had COVID-19-suggestive symptoms. Only 1 patient relapsed after receiving the COVID-19 vaccine. The six admitted patients who received RTX were negative for COVID-19 based on the PCR testing results. Out of the 12 patients, eight achieved complete remission, while four achieved partial remission. No major adverse effects were observed. In conclusion, the treatments with systemic steroids, immunosuppressive drugs, and rituximab were well tolerated by the patients with relapsing PV, provided that there was no contact with individuals with COVID-19. These treatments can then be provided to patients with PV during the pandemic with careful follow-up.

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Section: Discussioncontrasting

confidence: 58%

“…However, serious adverse reactions occurred in 22% of the patients in the RTX group compared with 15% of the patients in the MMF group. 9 In our study, none of the patients who received azathioprine or MMF experienced adverse effects. Further studies are needed to determine the safety of azathioprine and MMF during the pandemic.…”

Section: Discussionmentioning

confidence: 52%

Pemphigus vulgaris relapse during the coronavirus disease pandemic

Saleh

2022

Dermatologic Therapy

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“…In recent years, it has emerged as the front‐line therapy for pemphigus vulgaris, and gained a formal status following its approval by the US Food and Drug Administration in 2018. The efficacy of rituximab combined with systemic corticosteroids in treating pemphigus has been well established in prospective randomized controlled trials 6,7 . This study also identified a possible need for rituximab maintenance therapy, due to early relapses in the first year following treatment.…”

Section: Introductionmentioning

confidence: 82%

Early rituximab treatment is associated with increased and sustained remission in pemphigus patients: A retrospective cohort of 99 patients

Nosrati

Mimouni

Hodak

et al. 2022

Dermatologic Therapy

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“…Rituximab, a monoclonal Ab against the CD20 Ag of B cells, depletes B cells and has been used to treat pemphigus since the 2000s ( 71 72 ). Rituximab was found to strikingly shorten the time to clinical remission and reduce the use of systemic corticosteroid significantly compared to mycophenolate mofetil ( 71 73 ). In a meta-analysis, clinical remission was found to be achieved 3 to 6 months after rituximab therapy in 75% of pemphigus patients ( 74 ).…”

Section: Autoimmune Bullous Diseasesmentioning

confidence: 99%

Immunopathology and Immunotherapy of Inflammatory Skin Diseases

2022

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Recently, there have been impressive advancements in understanding of the immune mechanisms underlying cutaneous inflammatory diseases. To understand these diseases on a deeper level and clarify the therapeutic targets more precisely, numerous studies including in vitro experiments, animal models, and clinical trials have been conducted. This has resulted in a paradigm shift from non-specific suppression of the immune system to selective, targeted immunotherapies. These approaches target the molecular pathways and cytokines responsible for generating inflammatory conditions and reinforcing feedback mechanisms to aggravate inflammation. Among the numerous types of skin inflammation, psoriasis and atopic dermatitis (AD) are common chronic cutaneous inflammatory diseases. Psoriasis is a IL-17–mediated disease driven by IL-23, while AD is predominantly mediated by Th2 immunity. Autoimmune bullous diseases are autoantibody-mediated blistering disorders, including pemphigus and bullous pemphigoid. Alopecia areata is an organ-specific autoimmune disease mediated by CD8 + T-cells that targets hair follicles. This review will give an updated, comprehensive summary of the pathophysiology and immune mechanisms of inflammatory skin diseases. Moreover, the therapeutic potential of current and upcoming immunotherapies will be discussed.

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Rituximab versus Mycophenolate Mofetil in Patients with Pemphigus Vulgaris

Cited by 82 publications

References 14 publications

Pemphigus vulgaris relapse during the coronavirus disease pandemic

Pemphigus vulgaris relapse during the coronavirus disease pandemic

Early rituximab treatment is associated with increased and sustained remission in pemphigus patients: A retrospective cohort of 99 patients

Immunopathology and Immunotherapy of Inflammatory Skin Diseases

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