Prognostic Factors Predicting Remission Following Rituximab Therapy for Pemphigus Vulgaris

Pemphigus vulgaris is a chronic autoimmune blistering disease with significant morbidity. Rituximab, approved as its first-line treatment, effectively induces remission. However, few studies have analysed the prognostic factors for improved rituximab outcomes. Therefore, this study aimed to identify such factors in a cohort of pemphigus vulgaris patients. A total of 142 pemphigus vulgaris patients treated with rituximab at Sheba Medical Center, with data encompassing demographics, comorbidities, disease characteristics, and treatment outcomes, were retrospectively examined. Results showed that 61.9% of patients previously treated with mycophenolate mofetil achieved partial remission, whereas only 34.7% achieved complete remission. Patients with diabetes mellitus exhibited a significantly shorter median time to relapse compared with those without. Patients with a disease duration ≤ 16 months before rituximab therapy exhibited a shorter median time to relapse. Moreover, previous dapsone treatment extended time to relapse. Notably, sex, age at symptom onset and rituximab therapy, ethnicity, comorbidities, skin involvement, weight, rituximab dosing protocol, and other variables were not statistically significant between the complete remission and partial remission groups. These findings highlight the influence of specific patient characteristics and treatment histories on response to rituximab and time to relapse in pemphigus vulgaris patients. Understanding these factors can aid clinicians in predicting treatment outcomes and selecting the appropriate patient population for rituximab therapy.