Real-World Outcomes of Rituximab in Pemphigus: An Australian Tertiary Cohort

Rituximab is endorsed internationally as first-line therapy for moderate-to-severe pemphigus, but Australian guidelines position it as a rescue agent and local outcome data are limited. In this single-centre retrospective cohort, 24 adults with pemphigus vulgaris (n = 16) or pemphigus foliaceus (n = 8) received rituximab as part of routine care; median follow-up from first infusion was 24.9 months. Disease control was documented in all patients and complete remission in 20 (83%), of whom half subsequently relapsed despite most receiving more than one cycle. Adverse events occurred in eight patients (33%), predominantly mild infusion-related reactions, with one fatal pneumonia. These real-world data support planned maintenance after remission rather than single-course rescue use, and prospective multicentre study with standardised severity scoring.