The prompt use of rituximab could decrease adverse effects in patient with pemphigus vulgaris: A preliminary evaluation

Abstract

Background The systemic use of corticosteroid is the treatment of choice for patients with pemphigus vulgaris (PV), but adverse effects are frequent. To date, the use of rituximab (RTX) for PV patients is usually indicated when they failed first‐line immunosuppressive therapies. The early use of RTX could theoretically lessen adverse effects. Methods We performed a single‐center study on patients with predominantly oral PV, treated with systemic corticosteroid and the prompt use of 1000 mg of intravenous RTX two weeks apart. We evaluated the clinical response and the reported adverse effect during a period of 24 months, comparing those with a previously published series. Results The study group comprised 11 patients, while the control group comprised 98 patients. The average time to achieve complete clinical remission was 3.2 ± 2.72 months. Study group took steroids for a mean time of 11.09 ± 2.02 months, and they are all actually disease‐free with no medication. Only three patients (27.3%) developed plain side effects. The effect of the length of the corticosteroid therapy on the side effects (also adjusted by sex, age, and clinical oral involvement) was statistically different in the two groups: the prompt use of RTX reduced of 94% the chance to have adverse effects (P = .001). Conclusions This is the first report of the use of RTX as first line of therapy for PV patients with predominantly oral involvement. With the proposed regimen, the adverse effects have been minimized compared with classic systemic corticosteroid‐centered therapy. Multi‐center randomized controlled trail is however necessary.

A retrospective cohort study reporting rituximab treatment for 33 patients with immunobullous disease

“…There is an increasingly robust body of evidence in the literature for the efficacy and safety of RTX in pemphigus 2,6‐8,13‐15 . Approval for its use in the EU and USA followed the RITUX3 study 2 which was a randomised controlled trial of patients with newly diagnosed and previously untreated PV.…”

“…It has a broad range of indications including Non‐Hodgkin's lymphoma, chronic lymphocytic leukaemia, rheumatoid arthritis and granulomatosis with polyangiitis 4,5 . Thus far within dermatology and autoimmune bullous disorders, its role has been later in the disease course, after corticosteroids and conventional immunosuppressants have failed 6 . In the UK, NHS Clinical Commissioning Policy states that RTX should be used after treatment with systemic corticosteroid in combination with trials of at least two conventional immunosuppressants have proved inadequate to control disease 1 .…”

Cutaneous manifestations and considerations in COVID ‐19 pandemic: A systematic review

“…In addition to mentioned dermatoses, there are many other dermatological concerns during pandemic as there are several skin conditions that may be treated by anti‐inflammatory, Immunomodulatory drugs or biologic agents, from them, vesiculobullous disease, autoimmune disorders, collagen vascular disease, psoriasis and so forth, could be mentioned and patients with these type of diseases considered as immunocompromised 3 . These patients may need drug‐dosage or drug‐administration frequency alterations or even drug cessations during the time of pandemic especially in the case of personal infection or having a highly suspicious exposure that may leading to further disease aggravation or poorly disease controlling 4 …”

“…3 These patients may need drug-dosage or drug-administration frequency alterations or even drug cessations during the time of pandemic especially in the case of personal infection or having a highly suspicious exposure that may leading to further disease aggravation or poorly disease controlling. 4 Secondary dermatoses are other concerns in the pandemic, so occurrence of an acute new dermatose could be seen frequently; some due to stress-related causes such as Herpes Simplex, Herpes Zoster, patchy alopecia areata and some due to physicalenvironmental causes like acute allergic or irritant contact dermatitis or acute urticaria. 5 Moreover, some acute conditions have a tendency to become chronic, from these, telogen-effluvium, eczema, chronic contact dermatitis, neurocutaneous or psychocutaneous disorders could be noted.…”

Patients with specific skin disorders who are affected by COVID ‐19: What do experiences say about management strategies? A systematic review

“…40 In dermatology, one of the most important concerns in the pandemic setting is the manner of disease management especially in the case of patients under treatment with immunosuppressive immuno- course. [41][42][43][44][45][46][47][48] One of the most important perspectives in the field of dermatology is approaching to patients with any documented skin or mucosal disorders especially who are using immunomodulators and now are…”