complete remission and no adverse events were observed. However, 5 patients experienced grade 3 or 4 adverse events (1 patient had sepsis; 2, diabetes; 1, hypertension; and 2, endocrine disorders) between the initial cycle and the first rituximab maintenance infusion. At their last follow-up visit (median [range], 78 [42-147] months after the first cycle of rituximab), all 11 patients remained in complete remission, with 10 patients having discontinued rituximab maintenance therapy. Serum anti-desmoglein 1 and 3 antibody levels, which had been high before rituximab treatment, decreased markedly and remained below 14 U/mL during rituximab maintenance therapy (Table 2). Discussion | The results of this case series indicated that rituximab can be used as single maintenance therapy, without a systemic corticosteroid, with good efficacy and tolerance in patients having severe pemphigus requiring long-term therapy for prevention of relapse. This study supplements a previous one showing the efficacy of rituximab alone in the treatment of relapse to pemphigus initially controlled with a combination of rituximab and corticosteroid. 6 We found that treatment with rituximab alone, even at a low dose, not only prevented relapse but also maintained complete remission with a better benefit to risk ratio than treatment with corticosteroids. The maintenance therapy was shown to be effective for preventing relapse despite shortcomings inherent in retrospective studies (eg, heterogeneity of patient pemphigus history and variable length of rituximab maintenance therapy), highlighting the feasibility of such an approach. A progressive decrease in serum anti-desmoglein autoantibody levels to less than 14 U/mL occurred in all cases along with clinical complete remission even after maintenance therapy cessation. Practical questions remain about the rituximab treatment regimen, including the optimal dose (500 mg or 1 g), frequency of administration (every 6 months or 1 year), and immunologic criteria enabling treatment withdrawal (negative direct immunofluorescence results or low serum autoantibody levels), and the cost-effectiveness of this maintenance therapy in patients with pemphigus. The criteria we used to discontinue rituximab maintenance therapy were persistent complete clinical remission and serum anti-desmoglein 1 and 3 autoantibody levels less than 14 U/mL for at least 1 year. Further prospective studies are warranted to identify patients for treatment with maintenance rituximab therapy and to optimize long-term management of difficult-to-treat pemphigus.
No abstract
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.