Efficacy of Repeated Courses of Rituximab as Treatment for Pemphigus Vulgaris
Sharon Baum, Tal Raviv, Sarit Gilboa, Felix Pavlotsky, Aviv Barzilai
Rituximab targets the B-lymphocyte antigen CD20, providing pemphigus vulgaris patients with long-term remissions. However, the effects of repeated courses have not yet been established. This study aimed to evaluate the effect of repeated rituximab courses on remission length in pemphigus vulgaris. A total of 73 patients with pemphigus vulgaris treated with rituximab at a single centre were retrospectively analysed. Of 73 study participants (28 men, 45 women), 42 (58%) received a 2nd course of rituximab, 24 (33%) received a 3rd course, 4 (6%) received a 4th course, and one (1%) received a 5th course. Rituximab remained efficacious in each course, irrespective of previous treatments (complete remission 75–81%). Following the 2nd and 3rd courses, the results indicated longer remissions with reduced flare-ups, and the remission length increased with each subsequent course. We conclude that rituximab serves as a disease-modifying agent, notably for patients with moderate-to-severe pemphigus vulgaris.
A proportion of patients with pemphigus vulgaris treated with rituximab achieve complete remission; nevertheless, relapses generally occur at 6–12 months after the first treatment. We observed that with repeated cycles of treatment with rituximab, high efficacy is maintained and remission can be induced despite failures in previous cycles. With each subsequent cycle, an improvement is observed, with a substantially longer remission time, thus we conclude that rituximab is a potent disease-modifying agent in these patients.