Rituximab: A Review in Pemphigus Vulgaris

Frampton, James E.

doi:10.1007/s40257-019-00497-9

Cited by 53 publications

(55 citation statements)

References 39 publications

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“…There is an increasingly robust body of evidence in the literature for the efficacy and safety of RTX in pemphigus 2,6‐8,13‐15 . Approval for its use in the EU and USA followed the RITUX3 study 2 which was a randomised controlled trial of patients with newly diagnosed and previously untreated PV.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty‐six per cent of RTX‐treated patients had a relapse within 36 months, two‐thirds of them between months 6 and 12 2 . Indeed the increased efficacy of RTX in pemphigus has been reported when used as a first‐line therapy and importantly, it can reduce cumulative doses of corticosteroids and their subsequent side effects 7,14,15 . The use of RTX as a first‐line therapy in PV was further endorsed by the Delphi process international consensus group in 2020 7 .…”

Section: Discussionmentioning

confidence: 99%

“…There is an increasingly robust body of evidence in the literature for the efficacy and safety of RTX in pemphigus. 2, [6][7][8][13][14][15] Approval for its use in the EU and USA followed the RITUX3 study 2 which was a randomised controlled trial of patients with newly diagnosed and previously untreated PV. They reported that RTX plus short course prednisolone resulted in a > threefold higher rate of complete remission off prednisolone therapy and a > twofold decrease in the rate of moderate/severe relapse compared with standard prednisolone.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed the increased efficacy of RTX in pemphigus has been reported when used as a first-line therapy and importantly, it can reduce cumulative doses of corticosteroids and their subsequent side effects. 7,14,15 The use of RTX as a first-line therapy in PV was further endorsed by the Delphi process international consensus group in 2020. 7 The efficacy of prompt treatment with RTX in patients with PV and predominantly oral involvement has also been reported.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective cohort study reporting rituximab treatment for 33 patients with immunobullous disease

Watson

Carrozzo

Hampton

2020

J Oral Pathology Medicine

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Background Autoimmune bullous disorders, encompassing pemphigus and pemphigoid diseases, are associated with significant morbidity and mortality. This is in part due to high cumulative doses of corticosteroids in combination with immunosuppressant agents used in traditional treatment regimes. Rituximab is an antiCD20 monoclonal antibody which can induce complete remission, but it is currently unlicensed in the UK and approved only after other treatments have failed. Methods We report a retrospective cohort study of 33 patients with pemphigus and pemphigoid diseases treated with rituximab from a single tertiary centre from 2013 to 2019. Results “Complete remission off therapy” was achieved by 27.3% (n = 9), and a further 27.3% (n = 9) had complete remission on minimal therapy. Twenty‐one per cent (n = 7) had “partial remission on minimal therapy”; 9.1% (n = 3) patients were in the “consolidation phase,” and 12.1% (n = 4) had a “relapse/flare.” A steady reduction in prednisolone doses was observed post‐Rituximab infusion. Pre‐Rituximab the median dose of prednisolone was 20mg (range 10‐35, IQR 25), 15mg (range 9.5‐22.5, IQR 13) at 1 month, 9mg (range 5‐10, IQR 5) at 6 months, 4mg (range 0‐5mg, IQR 5) at 12 months and 0 (0‐4.35, IQR 4.25) at 18 months. Twelve per cent (n = 4) of patients had documented infusion reaction symptoms. Twelve per cent (n = 4) had later infective complications. Conclusion This real clinic data adds to the evidence that Rituximab is a safe and effective treatment for both pemphigus and pemphigoid autoimmune blistering conditions. Significantly, we were able to demonstrate a substantial reduction in corticosteroid dosage in our cohort of patients following rituximab treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A retrospective cohort study reporting rituximab treatment for 33 patients with immunobullous disease

Watson

Carrozzo

Hampton

2020

J Oral Pathology Medicine

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“…While ocrelizumab was approved for relapsing remitting and primary progressive MS, rituximab has been widely used for the treatment of MS for many years in some countries, particularly Sweden. Rituximab past experience in other auto-immune diseases indicates an increased risk of mild to moderate bacterial infections, except in systemic lupus erythematosus, where many opportunistic infections were noted, such as Salmonella typhimurium gastroenteritis, meningococcal meningitis, Listeria meningitis, oesophageal candidiasis, herpes zoster infection and reactivation, endocarditis, septicemia, cholangitis, and Pneumocystis jirovecii pneumonia as well as non-infectious complications such as mild to severe lymphopenia, posterior reversible encephalopathy syndrome, unstable angina, and hypogammaglobulinemia [ 179 , 180 , 181 , 182 , 183 , 184 , 185 , 186 , 187 ]. In lymphoid malignancies, whether used with or without other immunosuppressive medications, important adverse events related to rituximab were tumor lysis syndrome (acute kidney injury, hyperkalemia, hypocalcemia, hyperuricemia, or hyperphosphatemia); and severe mucocutaneous reactions (paraneoplastic pemphigus, Stevens Johnson syndrome, and toxic epidermal necrolysis) [ 188 , 189 ].…”

Section: Safety Of Newer Dmtsmentioning

confidence: 99%

Safety of Newer Disease Modifying Therapies in Multiple Sclerosis

et al. 2020

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In the past decade, the therapeutic arsenal for multiple sclerosis has expanded greatly. Newer more potent disease modifying therapies (DMTs) with varying mechanisms of actions are increasingly used early in the disease course. These newer DMTs include oral therapies (teriflunomide, dimethyl fumarate, fingolimod, siponimod, ozanimod, and cladribine) and infusion therapies (natalizumab, alemtuzumab, and ocrelizumab), and are associated with better control of disease activity and long-term outcomes in patients with MS compared to older injectable therapies (interferon beta and glatiramer acetate). However, they are associated with safety concerns and subsequent monitoring requirements. Adverse events are initially observed in phase 2 and 3 clinical trials, and further long-term data are collected in phase 3 extension studies, case series, and post-marketing reports, which highlight the need to periodically re-evaluate and adjust monitoring strategies to optimize treatment safety in an individualized approach.

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Bullous Dermatoses and Depression

et al. 2021

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ullous diseases affecting the skin and mucosa can have a substantial role in patients' quality of life and mental health. The most common bullous dermatoses include bullous pemphigoid and pemphigus vulgaris, which have an incidence of 4.3 and 0.1 to 0.7 per 100 000 persons worldwide, respectively. 1,2 Bullous pemphigoid and pemphigus vulgaris are both autoimmune bullous dermatoses, with antibodies to hemidesmosomes and desmoglein, respectively. 3 Epidermolysis bullosa (EB) is an inherited disorder caused by either autosomal dominant or recessive variants in genes that code structural proteins. Overall, bullous dermatoses are associated with substantial morbidity and mortality. Specifically, bullous dermatoses are associated with an increased risk of cardiovascular disease, 4 neurologic disease, 5 other autoimmune diseases, 6 and a negative outcome on quality of life. 7 Approximately 1 in 3 patients with skin disease experience depression,anddepressionhasbeenassociatedwithlowermedicationadherence and worsening disease severity among dermatology patients. 8,9 Patients with bullous skin diseases may be especially susceptible to developingmentalhealthcomorbiditiesowingtothechronicphysicaland emotional outcomes of these diseases. However, there is a critical lack of evidence synthesis on the prevalence of depression among patients with bullous skin diseases. This systematic review aims to synthesize andinterpretthecurrentevidenceondepressionanddepressivesymptoms among patients diagnosed with bullous dermatoses. Methods Search Strategy and Study SelectionIn conducting this review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. 10 We conducted searches of the PubMed, Embase, Cochrane, and PsycInfo databases in February 2021. This systematic review was prospectively registered with PROSPERO (CRD42021230750). Database searches included articles published between 1945 and February 2021 using MeSH search terms ("Skin Diseases, Vesiculobullous" [MeSH] AND "Depression" [MeSH]), as appropriate. The initial database searches yielded a total of 271 results (Figure).Two team members, S.P.P. and Y.G., reviewed the titles and abstracts of the articles and applied inclusion and exclusion criteria to determine eligibility for this review. We also reviewed reference lists of relevant articles. For this review, inclusion criteria included patients of all ages diagnosed with bullous skin disease who were screened for depression or diagnosed with depression. Articles without primary data, case reports, and those not limited to human study were excluded. All discrepancies were mediated by A.W.A. After reviewing article titles and abstracts, S.P.P. and Y.G. determined that 36 were eligible for full-text review. IMPORTANCE There is a lack of evidence synthesis on the association between bullous skin disease and depression.OBJECTIVE To synthesize and interpret the current evidence on the association between bullous skin disease and depression.EVIDENCE REVIEW This review was co...

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Rituximab: A Review in Pemphigus Vulgaris

Cited by 53 publications

References 39 publications

A retrospective cohort study reporting rituximab treatment for 33 patients with immunobullous disease

A retrospective cohort study reporting rituximab treatment for 33 patients with immunobullous disease

Safety of Newer Disease Modifying Therapies in Multiple Sclerosis

Bullous Dermatoses and Depression

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