Rituximab therapy in patients with bullous pemphigoid: A retrospective study of 20 patients

Polansky, Maura; Eisenstadt, Rachel; DeGrazia, Taryn; Zhao, Xiwen; Liu, Yuan; Feldman, Ron J.

doi:10.1016/j.jaad.2019.03.049

Cited by 50 publications

(53 citation statements)

References 30 publications

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“…Seventy five percent of BP patients achieved remission following a mean duration of 169 days of rituximab treatment in a retrospective study evaluating the efficacy of rituximab for patients with BP. This study also demonstrated that rituximab can be a relatively safe mode of therapy rituximab for patients with BP [ 168 ].…”

Section: Bullous Pemphigoidmentioning

confidence: 86%

The pathogenesis of bullous skin diseases

Yang

Zhao

et al. 2019

Journal of Translational Autoimmunity

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Bullous skin diseases are a group of dermatoses characterized by blisters and bullae in the skin and mucous membranes. The etiology and pathogenesis of bullous skin diseases are not completely clear. The most common are pemphigus and bullous pemphigoid (BP). Autoantibodies play critical roles in their pathogenesis. Abnormalities in the adhesion between keratinocytes in patients with pemphigus leads to acantholysis and formation of intra-epidermal blisters. Anti-desmoglein autoantibodies are present both in the circulation and skin lesions of patients with pemphigus. The deficient adhesion of keratinocytes to the basement membrane in BP patients gives rise to subepidermal blisters. Autoantibodies against the components of hemidesmosome can be detected in BP patients. Many novel therapeutics based on knowledge of the pathogenesis have emerged in recent years.

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Section: Bullous Pemphigoidmentioning

confidence: 86%

The pathogenesis of bullous skin diseases

Yang

Zhao

et al. 2019

Journal of Translational Autoimmunity

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“…The evidence for BP is similarly drawn from small case series and one systematic review 22‐24 . The review included 1 case series with 5 patients and 8 case reports comprising 11 patients, of which 4 were children.…”

Section: Discussionmentioning

confidence: 99%

“…The evidence for BP is similarly drawn from small case series and one systematic review. [22][23][24] The review included 1 case se-…”

Section: Discussionmentioning

confidence: 99%

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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“…Bullous pemphigoid (BP) is the most common autoimmune blistering disease, 1 usually occurring in the elderly. BP has been discussed in several recent issues of the Journal of Cutaneous Medicine and Surgery.…”

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confidence: 99%

“…1 Rituximab is a humanized monoclonal antibody targeting autoantibody producing CD20 +B and pre-B cells. 1 The study included 20 patients who received at least 1 dose of rituximab, using the protocols for rheumatoid arthritis (1 g repeated in 2 weeks) or lymphoma (375 mg/m 2 weekly for 4 weeks), either as initial therapy for severe BP or as a second-line therapy for recalcitrant disease after having failed one or more conventional treatments. A total of 75% of patients (N = 15) achieved durable remission an average 169 days following rituximab.…”

mentioning

confidence: 99%