Factors Associated With Complete Remission After Rituximab Therapy for Pemphigus

Kushner, Carolyn J.; Wang, Shiyu; Tovanabutra, Napatra; Tsai, Donald E.; Werth, Victoria P.; Payne, Aimee

doi:10.1001/jamadermatol.2019.3236

Cited by 47 publications

(52 citation statements)

References 28 publications

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“…All but six patients included in our study received this drug as the last‐line therapy for disease refractory to conventional immunosuppressive regimens. The CR rate after the first rituximab cycle was 73%, which is very close to 77% CR rate calculated for high‐dose rituximab regimens by Wang et al 3 or 71% recently reported by Kushner et al 6 A recent randomized controlled prospective study suggested that rituximab given as the first‐line therapy produces even better results with the CRoff rate of 89% at 24 months, supporting an early use of this drug in pemphigus 4 . In fact, all six patients in our cohort who received rituximab as the first‐line therapy also achieved CR.…”

Section: Discussionsupporting

confidence: 86%

“…In addition, most reports published long-term follow-up covering a time span of only about three years after the first rituximab therapy. 6,[8][9][10][11][12][13] In the current study, we sought to examine response and relapse rates in pemphigus patients followed for a considerably longer period of time. We, therefore, included only patients who continuously remained in our care for at least 36 months after the first rituximab cycle, yielding a median follow-up of 104 months (eight years and eight months).…”

Section: Discussionmentioning

confidence: 99%

“…While a longer follow‐up time is thought to be associated with higher relapse rates, 7 many studies have focused on short‐term effects of rituximab in pemphigus. In addition, most reports published long‐term follow‐up covering a time span of only about three years after the first rituximab therapy 6,8‐13 . In the current study, we sought to examine response and relapse rates in pemphigus patients followed for a considerably longer period of time.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes of rituximab therapy in pemphigus

Shimanovich

Baumann

Schmidt

et al. 2020

Acad Dermatol Venereol

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Background Rituximab induces a rapid remission in most patients with pemphigus. Objective Our aim was to assess the long-term efficacy of rituximab in this disease. Method We conducted a retrospective study of 59 patients with pemphigus treated with rituximab and observed over a median period of 104 months. Results The rate of complete remission off therapy (CRoff) after the first rituximab cycle was 39%, increasing to 61% with additional rituximab courses. Long-term CRoff was achieved in 27% of patients. The recurrence rate after the first rituximab cycle was 63%, decreasing to approximately 40% with subsequent rituximab cycles. Median time to relapse after the first and subsequent rituximab cycles was 25 months. Renewed rituximab therapy reinduced complete remission in 94% of cases. Baseline anti-desmoglein antibody levels of ≤250 U/mL were significantly associated with the outcome of CRoff. In paired serum samples obtained before the first and six months after the last rituximab therapy, significant reductions of desmoglein-specific autoantibodies were observed. Patients relapsing after a complete remission induced by the first rituximab cycle were more likely to achieve CRoff than patients relapsing after a less favourable outcome and non-responders. There was no significant difference in age, sex, pemphigus subtype, rituximab dosing and disease duration between patients achieving CRoff and those not meeting this end point. Conclusions Lower desmoglein-specific antibody levels at baseline were predictive of CRoff. In patients receiving multiple rituximab cycles, complete remission after the first cycle was associated with a favourable long-term outcome. Repeated rituximab courses were highly effective for relapsed disease and improved the overall outcome.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes of rituximab therapy in pemphigus

Shimanovich

Baumann

Schmidt

et al. 2020

Acad Dermatol Venereol

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“…We read with interest the letter published by Muntyanu et al, which highlighted the recent study from Kushner et al 1 Based on this paper, they suggested that the use of the lymphoma regimen (LR) for rituximab (RTX) could be considered in our practice to increase the rate of complete remission off therapy (CROT) in pemphigus patients.…”

mentioning

confidence: 99%

Reader Comment on “Rituximab Lymphoma-Protocol May Be Superior for Inducing Remission in Pemphigus Vulgaris”

Lemieux

Joly

2020

J Cutan Med Surg

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“…Kushner et al published the largest study to date exploring the efficacy of rituximab in PV/PF and predictors of response. 2 This single-center, retrospective, cohort study conducted from 2005 to 2016, included 96 PV and 16 PF patients. The primary end-point was complete response off therapy (CROT) after 1 cycle of treatment and factors associated with favorable response.…”

mentioning

confidence: 99%