Off-label use of rituximab in dermatology: pemphigus treatment

Bomm, Lislaine; Fracaroli, Tainá Scalfoni; Sodré, João Luz; Bressan, Aline Lopes; Gripp, Alexandre Carlos

doi:10.1590/abd1806-4841.20131905

Cited by 14 publications

(17 citation statements)

References 5 publications

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“…Rituximab treatment can cost $16,000 (Bomm et al 2013). Patients may benefit by switching to a more practical, safer, and cheaper alternative.…”

Section: Managementmentioning

confidence: 99%

A brief review of pemphigus vulgaris

Sanders

2017

biomed dermatol

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Pemphigus vulgaris is an autoimmune disorder which presents with painful mucocutaneous blisters and erosions. On the skin, they are flaccid bullae or erosions, and on the mucosa, they present as erosions. This disease is rare but is devastating to those who have it; it also is related-perhaps genetically-to other autoimmune conditions. This is to say that a patient can develop pemphigus vulgaris if they have thyroiditis or diabetes mellitus. Biopsy is needed to obtain histopathological evidence of the breakdown of intercellular connections due to the autoimmune attack on components of desmosomes, which are responsible for intercellular integrity above the basement membrane. When these desmosomes are attacked, loss of connection ensues, and the cells break apart at these connections; this leads to fluid buildup, seen grossly as bullae. Treatment of the disease is difficult and sometimes unsafe. For decades, the mainstay of treatment has been glucocorticoids followed by other drugs. Unfortunately, these drugs are systemically absorbed, and the side effect profile can be unfavorable. In the past several years however, more innovative treatments have emerged that may help ease the cost and safety burden to patients. This review highlights the major points about pemphigus vulgaris, its pathophysiology, and its treatment.

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“…Rituximab treatment can cost $16,000 (Bomm et al 2013). Patients may benefit by switching to a more practical, safer, and cheaper alternative.…”

Section: Managementmentioning

confidence: 99%

A brief review of pemphigus vulgaris

Sanders

2017

biomed dermatol

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“…Çoğu plazma hücresi CD20 antijeni eksprese ettiğinden dolayı, plazma hücreleri genellikle seyrekleşir ve serum immunglobulin seviyeleri dramatik olarak düşer. Bu durum rituksimabın seçici bir avantajıdır (1,6).…”

Section: Bölüm 1 Girişunclassified

“…Eliminasyon yarı ömrü tümör hasarının farklılığı ve tekrarlayan uygulamalarda CD20+ B hücre populasyonu değişikliğine göre farklı olabilir. Rituksimabın metabolizma ve atılım mekanizmaları tam olarak anlaşılamamasına karşın, karaciğer ve böbrek yoluyla spesifik olarak atılma yolu gösterilememiştir (1).…”

Section: Farmakokinetikunclassified

“…En sık solunum yolu bulguları arasında öksürük, rinit, bronkospazm, dispne ve sinü-zit yer almaktadır. Bronşiyolitis obliterans ve intersitisiyel pnömoni gibi fatal reaksiyonlar da gelişebilir (1,4).…”

Section: Sistemik Yan Etkilerunclassified

“…Emzirme döneminde süte insan IgG'si geçebildiğinden dolayı, rituksimab kullanan annelerin kan seviyeleri tamamen kaybolmasına kadar emzirmemesi önerilmektedir. Yaygın ilaç etkileşim çalışmaları yapılmamasına karşın, böbrek yetmezlik riski nedeniyle rituksimabın sisplatin ile birlikte uygulanmaması gerekmektedir (1,4).…”

Section: Kutanöz Yan Etkilerunclassified

See 2 more Smart Citations

Dermatolojide Rituksimab Kullanımı

2014

Dermatoz

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The Emerging Role of Rituximab in Autoimmune Blistering Diseases

Ahmed

Shetty

2015

Am J Clin Dermatol

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Rituximab is a chimeric monoclonal antibody that selectively binds to the CD20 molecule on B cells, resulting in their lysis. In autoimmune blistering diseases, the auto-antibody-producing B cells are destroyed and auto-antibody levels are reduced or eliminated. In the majority of patients, rituximab produces rapid clinical response and early resolution. In part, this accounts for the increased use of rituximab. Rituximab does not distinguish normal from pathologic B cells. Hence, shortly after its use, B-cell levels are zero and remain so for several months. In most patients, the use of systemic corticosteroids and immunosuppressive agents are continued after rituximab therapy, while their dosages are significantly decreased. In the majority of patients rituximab is used according to the protocol used in treating lymphoma patients or patients with rheumatoid arthritis. Approximately 50% of patients experience a relapse, requiring additional therapy. Serious adverse events and fatal outcomes have been reported, although their incidence is less than that observed with conventional therapy. Nonetheless, the causes, i.e. infections and septicemia, are similar. Several gaps exist in our understanding of how to optimally benefit from the use of this valuable biological agent. Future studies need to be targeted in designing and implanting protocols that maximize the benefit of rituximab and result in producing sustained prolonged remissions with minimal adverse events and a high quality of life.

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Off-label use of rituximab in dermatology: pemphigus treatment

Cited by 14 publications

References 5 publications

A brief review of pemphigus vulgaris

A brief review of pemphigus vulgaris

Dermatolojide Rituksimab Kullanımı

The Emerging Role of Rituximab in Autoimmune Blistering Diseases

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