Low-dose rituximab is effective in pemphigus

Area of Science:

• Immunodermatology
• Autoimmune Blistering Diseases

Background:

• Rituximab, an anti-CD20 antibody, is approved for B-cell malignancies.
• Previous studies showed efficacy of rituximab at 4 × 375 mg/m² for pemphigus.

Purpose of the Study:

• To investigate the efficacy of a lower rituximab dose for pemphigus treatment.

Main Methods:

• 15 patients with pemphigus (3 PF, 12 PV) received two 500 mg rituximab infusions, 2 weeks apart.
• Monitoring included clinical outcomes, B-cell counts, and anti-desmoglein antibody indices.

Main Results:

• All 15 patients responded to therapy.
• Eight achieved complete remission (median 5 weeks), seven partial remission (median 34.5 weeks).
• Relapses occurred in 40% between 53-103 weeks; B-cell depletion was significant and sustained in remission.

Conclusions:

• A lower rituximab dose is effective and safe for pemphigus.
• Relapses are possible, particularly around the second year.
• Cost-effectiveness studies are necessary to determine optimal rituximab dosage for pemphigus.