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Delvaux C, Bohelay G, Sitbon IY, Soued I, Alexandre M, Cucherousset J, Gilardin L, Diep A, Caux F, Le Roux-Villet C. Activity of apremilast in a patient with severe pemphigus vulgaris: case report. Front Immunol 2024; 15:1404185. [PMID: 38983857 PMCID: PMC11231183 DOI: 10.3389/fimmu.2024.1404185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/03/2024] [Indexed: 07/11/2024] Open
Abstract
Introduction Although the treatment for pemphigus vulgaris (PV) has been revolutionized by the use of rituximab combined with corticosteroids, new effective therapies with a better safety profile are needed. Observation A 67-year-old woman was diagnosed with severe mucosal PV, which was initially misdiagnosed as atypical Behçet's disease. Following an unsuccessful colchicine treatment, significant improvement was observed upon the introduction of apremilast: reduced pain, fewer lesions, and a stabilized weight. The discontinuation of apremilast led to a rapid relapse. Retrospective analysis through anti-Dsg3 ELISA indicated a gradual decrease in antibody levels during the apremilast treatment. Discussion Apremilast, a phosphodiesterase 4 inhibitor approved for psoriasis and Behçet's disease's related oral ulcers treatment, demonstrated its efficacy in this PV case. This is the second case report highlighting the effectiveness of apremilast for PV treatment. Apremilast's ability to upregulate cyclic adenosine monophosphate (cAMP) levels appears to contribute to the stabilization of keratinocyte adhesion. Conclusion Apremilast may be a promising therapeutic option for the treatment of pemphigus, with an innovative mechanism of action, no induced immunosuppression, and good tolerance. It could be a good alternative to steroids, in the treatment regimen of steroids combined with rituximab.
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Affiliation(s)
- Cheyenne Delvaux
- Department of Dermatology, Saint-Pierre and Brugmann University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Gérôme Bohelay
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Ishaï-Yaacov Sitbon
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Isaac Soued
- Department of ENT, Avicenne Hospital AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Marina Alexandre
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Joël Cucherousset
- Department of Pathology, Avicenne Hospital AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Laurent Gilardin
- Department of Internal Medicine, Jean-Verdier Hospital, Bondy, France
| | - Antoine Diep
- Department of Immunology, Saint-Louis Hospital, Paris, France
| | - Frédéric Caux
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Christelle Le Roux-Villet
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
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Carver CA, Kalesinskas M, Ahmed AR. Current biologics in treatment of pemphigus foliaceus: a systematic review. Front Immunol 2023; 14:1267668. [PMID: 37901249 PMCID: PMC10600482 DOI: 10.3389/fimmu.2023.1267668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Background Pemphigus foliaceus (PF) differs from pemphigus vulgaris (PV) in that it affects only the skin and mucous membranes are not involved. Pemphigus is commonly treated with systemic corticosteroids and immunosuppressive agents (ISAs). More recently, biologics have been used. The current literature on biologic therapy often combines treatment of PF with PV, hence it is often difficult for clinicians to isolate the treatment of PF from PV. The purpose of this review was to provide information regarding the use of current biological therapy, specifically in PF. Materials and methods A search of PubMed, Embase, and other databases was conducted using keywords pemphigus foliaceus (PF), rituximab (RTX), intravenous immunoglobulin (IVIg), and biologics. Forty-one studies were included in this review, which produced 105 patients with PF, treated with RTX, IVIg, or a combination of both. Eighty-five patients were treated with RTX, eight patients with IVIg, and 12 received both RTX and IVIg. Results Most patients in this review had PF that was nonresponsive to conventional immunosuppressive therapies (CIST), and had significant side effects from their use. RTX treatment resulted in complete remission (CR) in 63.2%, a relapse rate of 39.5%, an infection rate of 19.7%, and a mortality rate of 3.9%. Relapse was greater in the lymphoma (LP) protocol than the rheumatoid arthritis (RA) protocol (p<0.0001). IVIg led to CR in 62.5% of patients, with no relapses or infections. Patients receiving both biologics experienced better outcomes when RTX was first administered, then followed by IVIg. Follow-up durations for patients receiving RTX, IVIg, and both were 22.1, 24.8, and 35.7 months, respectively. Discussion In pemphigus foliaceus patients nonresponsive to conventional immunosuppressive therapy or in those with significant side effects from CIST, RTX and IVIg appear to be useful agents. Profile of clinical response, as well as relapse, infection, and mortality rates in PF patients treated with RTX were similar to those observed in PV patients. The data suggests that protocols specific for PF may produce better outcomes, less adverse effects, and improved quality of life.
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Affiliation(s)
- Caden A. Carver
- Midwestern University, Arizona College of Osteopathic Medicine, Glendale, AZ, United States
| | - Mikole Kalesinskas
- Department of Dermatology, Center for Blistering Disease, Tufts University School of Medicine, Boston, MA, United States
| | - A. Razzaque Ahmed
- Department of Dermatology, Center for Blistering Disease, Tufts University School of Medicine, Boston, MA, United States
- Department of Dermatology, Tufts University School of Medicine, Boston, MA, United States
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Jo JC, Jeon Y, Kim D, Yang DH, Lee WS, Choi YS, Yi JH, Yoon DH, Kong JH, Choe JY, Kim S, Ahn K, Park T, Ju H, Kwon S, Cho SG. A non-interventional, post-marketing surveillance study evaluating the safety and effectiveness of biosimilar rituximab (CT-P10) during routine clinical practice in the Republic of Korea. Expert Opin Biol Ther 2023; 23:737-747. [PMID: 36757373 DOI: 10.1080/14712598.2023.2177101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND CT-P10 was the first licensed rituximab biosimilar. This Korean post-marketing surveillance study evaluated CT-P10 safety and effectiveness in approved indications. RESEARCH DESIGN AND METHODS This prospective, open-label, observational, phase 4 study collected routine clinical practice data across 27 centers in the Republic of Korea. Patients received their first CT-P10 treatment, per prescribing information, for non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL), rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA) during the surveillance period (16 November 2016-15 November 2020). Safety (including adverse events [AEs] and adverse drug reactions [ADRs]) and disease-specific clinical response (by best overall response [NHL/CLL], Disease Activity Score in 28-joints [RA], or Birmingham Vasculitis Activity Score for Wegener's Granulomatosis [GPA/MPA]) were assessed for ≤1 year (NHL/CLL) or ≤24 weeks (RA/GPA/MPA). RESULTS The safety population comprised 677 patients (604 NHL, 16 CLL, 42 RA, 7 GPA, 8 MPA). AEs/ADRs were reported for 68.4%/27.7% (NHL/CLL), 31.0%/14.3% (RA), and 86.7%/13.3% (GPA/MPA) of patients. Serious AEs and unexpected ADRs did not raise new safety signals. Pneumonia was the most frequent serious ADR overall. Positive effectiveness outcomes were observed. CONCLUSIONS Findings were consistent with the known CT-P10/reference rituximab safety profile, with high effectiveness observed in NHL/CLL and RA.
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Affiliation(s)
- Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Youngwoo Jeon
- Department of Hematology, Lymphoma and Cell Therapy-Research Center, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - DaJung Kim
- Department of Internal Medicine, Kosin University College of Medicine, Kosin University, Seo-gu, Busan, Republic of Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Won Sik Lee
- Department of Internal Medicine, Hemato-oncology, Inje University Busan Paik Hospital, Busangjin-gu, Busan, Republic of Korea
| | - Yoon Seok Choi
- Department of Hematology-Oncology, Ajou University Hospital, Suwon, Gyeonggi-do, Republic of Korea
| | - Jun Ho Yi
- Department of Internal Medicine, Division of Hematology and Oncology, Chung-ang University Hospital, Dongjak-gu, Seoul, Republic of Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Jee Hyun Kong
- Department of Hematology-Oncology, Division of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Gangwon-do, Republic of Korea
| | - Jung-Yoon Choe
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Nam-gu, Daegu, Republic of Korea
| | - SungHyun Kim
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - KeumYoung Ahn
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - TaeHong Park
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - Hana Ju
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - Soonbum Kwon
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - Seok-Goo Cho
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
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Athni TS, Barmettler S. Hypogammaglobulinemia, late-onset neutropenia, and infections following rituximab. Ann Allergy Asthma Immunol 2023; 130:699-712. [PMID: 36706910 PMCID: PMC10247428 DOI: 10.1016/j.anai.2023.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/23/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
Rituximab is a chimeric anti-CD20 monoclonal antibody that targets CD20-expressing B lymphocytes, has a well-defined efficacy and safety profile, and is broadly used to treat a wide array of diseases. In this review, we cover the mechanism of action of rituximab and focus on hypogammaglobulinemia and late-onset neutropenia-2 immune effects secondary to rituximab-and subsequent infection. We review risk factors and highlight key considerations for immunologic monitoring and clinical management of rituximab-induced secondary immune deficiencies. In patients treated with rituximab, monitoring for hypogammaglobulinemia and infections may help to identify the subset of patients at high risk for developing poor B cell reconstitution, subsequent infections, and adverse complications. These patients may benefit from early interventions such as vaccination, antibacterial prophylaxis, and immunoglobulin replacement therapy. Systematic evaluation of immunoglobulin levels and peripheral B cell counts by flow cytometry, both at baseline and periodically after therapy, is recommended for monitoring. In addition, in those patients with prolonged hypogammaglobulinemia and increased infections after rituximab use, immunologic evaluation for inborn errors of immunity may be warranted to further risk stratification, increase monitoring, and assist in therapeutic decision-making. As the immunologic effects of rituximab are further elucidated, personalized approaches to minimize the risk of adverse reactions while maximizing benefit will allow for improved care of patients with decreased morbidity and mortality.
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Affiliation(s)
| | - Sara Barmettler
- Allergy and Clinical Immunology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts.
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5
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Yamagami J. B-cell targeted therapy of pemphigus. J Dermatol 2023; 50:124-131. [PMID: 36478455 PMCID: PMC10107866 DOI: 10.1111/1346-8138.16653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
Pemphigus is an autoimmune disease that causes blistering and erosion of the skin and mucous membranes because of autoantibodies against desmoglein, which plays an important role in adhesion between epidermal keratinocytes. Treatment of pemphigus has long been centered on corticosteroids, and the guidelines for management of pemphigus have recommended high-dose systemic corticosteroids as the first-line treatment. While guideline-based treatment has been shown to be beneficial in patients with pemphigus, it has also become clear that this treatment is accompanied by significant burden and risk. The challenge for future pemphigus treatment is to maximize efficacy while minimizing risk during the course of the disease. In this regard, treatment targeting B cells is expected to become increasingly important as autoreactive B cells in pemphigus patients are thought to play a major role in the production of autoantibodies, which form the basis of the pathogenesis. The recent expansion of insurance coverage to rituximab, a monoclonal antibody against CD20, for refractory pemphigus in the USA, Europe, and Japan has opened up a new era of pemphigus treatment by enabling treatment strategies with drugs targeting B cells in patients. Here, we discuss the current status and future prospects of pemphigus treatment, focusing on rituximab and Bruton's tyrosine kinase inhibitors, which are expected to become essential drugs for pemphigus treatment in the future.
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Affiliation(s)
- Jun Yamagami
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
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6
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Yamagami J, Kurihara Y, Funakoshi T, Saito Y, Tanaka R, Takahashi H, Ujiie H, Iwata H, Hirai Y, Iwatsuki K, Ishii N, Sakurai J, Abe T, Takemura R, Mashino N, Abe M, Amagai M. Rituximab therapy for intractable pemphigus: A multicenter, open-label, single-arm, prospective study of 20 Japanese patients. J Dermatol 2023; 50:175-182. [PMID: 36196051 PMCID: PMC10091989 DOI: 10.1111/1346-8138.16597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 02/04/2023]
Abstract
This was a multicenter clinical trial of rituximab, a chimeric monoclonal IgG antibody directed against CD20, for the treatment of refractory pemphigus vulgaris and pemphigus foliaceus. In total, 20 patients were treated with two doses of rituximab (1000 mg; 2 weeks apart) on days 0 and 14. The primary end point was the proportion of patients who achieved complete or partial remission on day 168 following the first rituximab dose. Of the 20 enrolled patients, 11 (55%) and four (20%) achieved complete and partial remission, respectively; therefore, remission was achieved in a total of 15 patients (75.0% [95% confidence interval, 50.9%-91.3%]). It was demonstrated that the remission rate was greater than the prespecified threshold (5%). In addition, a significant improvement in clinical score (Pemphigus Disease Area Index) and decrease in serum anti-desmoglein antibody level were observed over time. Four serious adverse events (heart failure, pneumonia, radial fracture, and osteonecrosis) were recorded in two patients, of which only pneumonia was considered causally related with rituximab. The level of peripheral blood CD19-positive B lymphocytes was decreased on day 28 after rituximab treatment and remained low throughout the study period until day 168. Our results confirm the efficacy and safety of rituximab therapy for refractory pemphigus in Japanese patients.
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Affiliation(s)
- Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.,Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichi Kurihara
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuko Saito
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Tanaka
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hayato Takahashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoji Hirai
- Department of Dermatology, Okayama University School of Medicine, Okayama, Japan
| | - Keiji Iwatsuki
- Department of Dermatology, Okayama University School of Medicine, Okayama, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Takayuki Abe
- Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan.,Yokohama City University School of Data Science, Yokohama, Japan
| | - Ryo Takemura
- Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Mashino
- Prescription Products Development Department, Zenyaku Kogyo Co., Ltd., Tokyo, Japan
| | - Masahiro Abe
- Prescription Products Development Department, Zenyaku Kogyo Co., Ltd., Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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7
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Oh S, Payne AS. Engineering Cell Therapies for Autoimmune Diseases: From Preclinical to Clinical Proof of Concept. Immune Netw 2022; 22:e37. [PMID: 36381961 PMCID: PMC9634148 DOI: 10.4110/in.2022.22.e37] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 11/05/2022] Open
Abstract
Autoimmune diseases are caused by a dysfunction of the acquired immune system. In a subset of autoimmune diseases, B cells escaping immune tolerance present autoantigen and produce cytokines and/or autoantibodies, resulting in systemic or organ-specific autoimmunity. Therefore, B cell depletion with monoclonal Abs targeting B cell lineage markers is standard care therapy for several B cell-mediated autoimmune disorders. In the last 5 years, genetically-engineered cellular immunotherapies targeting B cells have shown superior efficacy and long-term remission of B cell malignancies compared to historical clinical outcomes using B cell depletion with monoclonal Ab therapies. This has raised interest in understanding whether similar durable remission could be achieved with use of genetically-engineered cell therapies for autoimmunity. This review will focus on current human clinical trials using engineered cell therapies for B cell-associated autoimmune diseases.
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Affiliation(s)
- Sangwook Oh
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aimee S. Payne
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, USA
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8
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Shah BJ, Mistry D, Shah SR. Long term efficacy and safety analysis of single cycle of biosimilar Rituximab in pemphigus: A retrospective study of 76 patients from India. Dermatol Ther 2022; 35:e15704. [PMID: 35808907 DOI: 10.1111/dth.15704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pemphigus poses a therapeutic challenge and Rituximab is increasingly used in its treatment. Long term data regarding efficacy and safety of Rituximab in pemphigus is limited. METHODS This study was a retrospective analysis of 76 pemphigus patients with primary endpoint being the percentage of patients achieving complete remission (CR) on/off therapy. Secondary endpoints were time to relapse, mean cumulative dose of prednisolone after Rituximab infusion, mean duration of follow up and adverse events to Rituximab if any. RESULTS A total of 62 (82.7%) attained complete remission on/off treatment, out of which 42 were off therapy. Mean interval between first dose rituximab administration and complete remission off treatment was 6.9 ± 3.7 months. Complete remission off treatment was sustained for a mean duration of 21.4 ± 17.8 months before relapse. Over a mean follow-up duration of 42.7 ± 24.9 months (median 41, maximum 83 months), 22 of 62 patients (35.5%) who had achieved complete remission after the first cycle of rituximab relapsed. A mean total cumulative dose of 8716.3 ± 10533.8 mg prednisolone was prescribed over a mean duration of 18.05 ± 15.64 months after the first cycle of rituximab. Adverse events were noted in 18 out of 76 patients (23.7%) which included infusion reactions (n=3), minor infections (n=7), transitory disease flare (n=6) and mortality (n=2). No statistically significant correlation was found between remission/relapse rates and age, gender, pemphigus subtype or disease duration. CONCLUSION This study substantiates the long-term efficacy and safety of single cycle of Rituximab in pemphigus.
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Affiliation(s)
- Bela J Shah
- B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Deval Mistry
- B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Shikha R Shah
- B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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9
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Yuan H, Pan M, Chen H, Mao X. Immunotherapy for Pemphigus: Present and Future. Front Med (Lausanne) 2022; 9:901239. [PMID: 35783635 PMCID: PMC9240651 DOI: 10.3389/fmed.2022.901239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Pemphigus is a chronic and severe autoimmune bullous disease caused by autoantibodies targeting adhesion molecules between keratinocytes. It requires 2–3 years on average to manage the disease. To date, although Rituximab combined with short-term systemic glucocorticoids was accepted as first-line therapy, systemic glucocorticoids remain the primary therapeutic option for pemphigus patients, successfully decreasing morbidity and mortality from pemphigus. However, novel therapeutic strategies are desirable due to the low efficacy in some subset of patients and the long-term severe adverse effects of traditional therapies. Recently, immunotherapy has proved to be encouraging for disease control or cure. Based on the current understanding of the immune mechanisms of pemphigus, we review the immune targets and corresponding agents applied in practice or under clinical trials. The goals of the novel treatments are to improve the quality of life of pemphigus patients by improving efficacy and safety, minimizing side effects, achieving fast disease control, or curing the disease.
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Affiliation(s)
- Huijie Yuan
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongxiang Chen
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuming Mao
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Xuming Mao
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10
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Miše J, Jukić IL, Marinović B. Rituximab - Progress but Still Not a Final Resolution for Pemphigus Patients: Clinical Report From a Single Center Study. Front Immunol 2022; 13:884931. [PMID: 35592312 PMCID: PMC9110665 DOI: 10.3389/fimmu.2022.884931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
Pemphigus is a rare autoimmune disease characterized by the production of pathogenic autoantibodies against desmosomal adhesion proteins, desmoglein 1 and 3. The pathophysiological process leads to the development of blisters and erosions on mucosal and/or skin surfaces as the main clinical manifestation of the disease. Rituximab emerged as the first-line therapeutic option for pemphigus due to its ability to induce remission by depleting peripheral B lymphocytes. Our aim was to assess the efficacy of rituximab in the treatment of patients in Croatia. A single-center, retrospective study was conducted on 19 patients treated with rituximab following a rheumatoid arthritis dosing protocol between October 2015 and March 2021, with a mean follow-up of 24.1 months. After the first rituximab cycle, two patients achieved complete remission off therapy (10.5%), and six patients achieved complete remission on minimal therapy (31.6%). Partial remission was observed among ten patients (52.6%). Eight patients (44.4%) relapsed after the first rituximab cycle. The mean relapse time was 21 months. Seven patients received two rituximab cycles, and three patients received three cycles. Overall, 13 out of 19 patients experienced complete remission at some point during the study, while there were no non-responders after the rituximab treatment. No statistically significant associations were observed between age, sex, type of disease involvement and clinical remission, either on or off therapy. A steady decrease in anti-desmoglein 1 and anti-desmoglein 3 levels was measured among all patients following rituximab treatment. One patient experienced a treatment-related adverse event of infectious etiology (cellulitis). One patient died following the first rituximab cycle, with the cause of death likely not to be associated with the treatment. Rituximab is an effective disease-modifying agent in the treatment of pemphigus with the main benefit of reducing corticosteroid exposure and steroid-related side effects among pemphigus patients. However, a feature of rituximab therapy is high relapse rates and the need for repeated treatment cycles to achieve complete remission. Developing an optimal protocol for rituximab treatment and finding suitable markers for predicting relapse will improve the management of pemphigus patients.
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Affiliation(s)
- Joško Miše
- Department of Dermatology and Venereology, European Reference Network (ERN) – Skin Reference Center, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ines Lakoš Jukić
- Department of Dermatology and Venereology, European Reference Network (ERN) – Skin Reference Center, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Branka Marinović
- Department of Dermatology and Venereology, European Reference Network (ERN) – Skin Reference Center, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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11
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Pagani K, Lukac D, Bhukhan A, McGee JS. Cutaneous Manifestations of Inflammatory Bowel Disease: A Basic Overview. Am J Clin Dermatol 2022; 23:481-497. [PMID: 35441942 DOI: 10.1007/s40257-022-00689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/30/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal (GI) tract that is subdivided into Crohn's disease (CD) and ulcerative colitis (UC). CD is characterized by involvement of the entire GI tract, while UC mainly affects the distal GI tract. Moreover, both CD and UC can present with extraintestinal manifestations (EIMs) of the disease affecting multiple organ systems including the hepatobiliary tract, kidney, bones, eyes, joints, and skin. These complications can cause significant morbidity and negatively impact the quality of life for IBD patients. Although the pathogenesis of EIMs is not clearly elucidated, it is postulated that the diseased GI mucosa similarly stimulates excess immune responses at the extraintestinal sites. Cutaneous EIMs occur in up to 15% of patients with IBD, often predating their IBD diagnosis. They are categorized into (1) specific, (2) reactive, (3) associated, and (4) treatment-induced. Here, we review the epidemiological, clinical, diagnostic, and histologic features of the most commonly described cutaneous EIMs of IBD along with their respective treatment options.
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Affiliation(s)
- Kyla Pagani
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Danitza Lukac
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aashni Bhukhan
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Ft. Lauderdale, FL, USA
| | - Jean S McGee
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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12
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Verma G, Sharma A, Rattan R, Negi A, Gupta M, Sharma R. Experience of Rituximab Therapy in Pemphigus: A Three-Year Retrospective Study from a Sub-Himalayan State. Indian J Dermatol 2022; 67:477. [PMID: 36578732 PMCID: PMC9792066 DOI: 10.4103/ijd.ijd_169_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Pemphigus is a group of auto-immune blistering disorders, characterised clinically by mucocutaneous blisters and erosions and histopathologically by intra-epidermal acantholysis. It was traditionally associated with high morbidity and mortality. The use of rituximab has brought upon a new dawn in the treatment of pemphigus. Aim A retrospective analysis to ascertain the efficacy, tolerance, adverse effect profile, remission, and relapse with the use of rituximab. Material and Methods A retrospective analysis of all diagnosed pemphigus patients who received rituximab therapy over a period of 3 years was performed. The patient's baseline characteristics, disease duration, clinical presentations, mucosal involvement, disease-severity assessment, and adverse events with rituximab were noted. The outcomes were evaluated based on the definitions of the disease-outcome parameters as early and late endpoints. Results Of the 17 pemphigus patients, there were 14 females (82.4%) and three males (17.6%) with a mean age of 35.9 ± 16.5 years (range: 9-65 years). Pemphigus vulgaris (PV) was the predominant type in 11 (64.7%) patients. After rituximab infusion, the 17 patients attained the end of consolidation phase (ECP) within 15 days to 3 months, and the mean duration was 1.24 months. The complete remission (CR on/off) ranged from 0.5 to 35 months, and the mean duration of remission was 21.7 months. Within a median time of 4.2 months, almost 80% patients achieved CR on therapy. Nine (53%) patients were in CR without any therapy till the end of the study period, and eight (47%) were in remission while on minimal therapy. Conclusion Rituximab is an efficacious therapeutic agent for pemphigus and is better tolerated and safer to all the previous medications used in the treatment.
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Affiliation(s)
- Ghanshyam Verma
- From the Department of Dermatology, Indira Gandhi Medical College, Shimla, HP, India
| | - Aditi Sharma
- From the Department of Dermatology, Indira Gandhi Medical College, Shimla, HP, India,Address for correspondence: Dr. Aditi Sharma, Department of Dermatology, Indira Gandhi Medical College, Shimla - 171 001, HP, India. E-mail:
| | - Renu Rattan
- From the Department of Dermatology, Indira Gandhi Medical College, Shimla, HP, India
| | - Ajeet Negi
- From the Department of Dermatology, Indira Gandhi Medical College, Shimla, HP, India
| | - Mudita Gupta
- From the Department of Dermatology, Indira Gandhi Medical College, Shimla, HP, India
| | - Rajni Sharma
- From the Department of Dermatology, Indira Gandhi Medical College, Shimla, HP, India
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13
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Shahrigharahkoshan S, Dadkhahfar S, Mozafari N, Shahidi-Dadras M. A review of reported infectious events following rituximab therapy in pemphigus patients. Dermatol Ther 2021; 35:e15264. [PMID: 34907628 DOI: 10.1111/dth.15264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/27/2022]
Abstract
Pemphigus is a rare autoimmune blistering condition that used to be fatal before the introduction of corticosteroid (CS) and immunosuppressive agents. Rituximab is a monoclonal anti-CD-20 antibody that induces the pathologic B-cells apoptosis with significant efficacy in the treatment of pemphigus. The application of rituximab can lead to infectious events. We aim to review the reported infectious events in pemphigus patients who previously received rituximab and classify them based on the causative agents. A thorough search of PubMed was conducted using the keywords "rituximab," "pemphigus," "infection," "viral disease," "viral infection," "complication," "efficacy" and their combinations also applying their equivalent Mesh terms and including the references cited in each study. All studies that mentioned at least one infectious event were included. A total of 77 infectious events in 68 patients were reported in the literature out of which the most reported causative agent was viral but the most fatal one found to be bacterial. Although rituximab therapy has shown promising results in controlling pemphigus patients mainly the refractory cases, given possible fatal outcomes, we believe the medical profile of the patients before initiating the therapy warrants careful examination to search for any risk factors or predisposing conditions.
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Affiliation(s)
| | - Sahar Dadkhahfar
- Skin research center, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - Nikoo Mozafari
- Skin research center, Shahid Beheshti University of medical sciences, Tehran, Iran
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14
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Perifani V, Dalamaga M, Theodoropoulos K, Theotokoglou S, Syrmali A, Loumou P, Papadavid E. Real world evidence: Patients with refractory pemphigus treated with Rituximab. Metabol Open 2021; 12:100142. [PMID: 34746731 PMCID: PMC8551647 DOI: 10.1016/j.metop.2021.100142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Pemphigus is a group of autoimmune blistering diseases, potentially life-threatening. Rituximab received FDA approval in June 2018 for the treatment of moderate to severe pemphigus vulgaris. OBJECTIVES To evaluate the efficacy and safety of rituximab in patients with pemphigus, resistant to previous therapies or unable to receive classic immunosuppressive treatment due to serious adverse events or comorbidities. MATERIALS AND METHODS Twenty-five patients (9 men, 16 women), mean age 49.4 ± 15.9 years (range 21-74 years), mean disease duration 4 ± 2.7 years (range 0.25-10 years) were included in the study: 19 patients with pemphigus vulgaris and 6 with pemphigus foliaceous. The efficacy of rituximab was evaluated according to the control of disease, retention of remission, disease severity, previous treatments and adverse reactions. During COVID-19 pandemic patients are monitored closely through tele-dermatology. RESULTS Twenty-three out of 25 patients had great improvement, 2 out of 25 ceased therapy due to adverse events (arthralgias and dyspnea). Sixteen out of 23 received additional course after 8 months (range 5-60 months). More aged patients presented more frequently adverse events and underwent additional courses (p = 0.002). Rituximab was found superior to classic immunosuppressive treatment in terms of efficacy and safety, with larger periods of remission and lower doses of corticosteroids and immunosuppressants. No major adverse events were noticed. CONCLUSIONS Rituximab is a very effective treatment of pemphigus and, remarkably, superior to classic immunosuppressive treatment.
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Affiliation(s)
- Vagiani Perifani
- 2nd Department of Dermatology and Venereology, Unit of Autoimmune Skin Disorders, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Athens, Greece
| | - Maria Dalamaga
- 2nd Department of Dermatology and Venereology, Unit of Autoimmune Skin Disorders, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Athens, Greece
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 115 27, Athens, Greece
| | - Konstantinos Theodoropoulos
- 2nd Department of Dermatology and Venereology, Unit of Autoimmune Skin Disorders, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Athens, Greece
| | - Sofia Theotokoglou
- 2nd Department of Dermatology and Venereology, Unit of Autoimmune Skin Disorders, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Athens, Greece
| | - Anna Syrmali
- 2nd Department of Dermatology and Venereology, Unit of Autoimmune Skin Disorders, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Athens, Greece
| | - Panagiota Loumou
- 2nd Department of Dermatology and Venereology, Unit of Autoimmune Skin Disorders, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Athens, Greece
| | - Evangelia Papadavid
- 2nd Department of Dermatology and Venereology, Unit of Autoimmune Skin Disorders, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Athens, Greece
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15
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Huseynova Terzi L, Akdogan N, Dogan Gunaydin S, Atakan N. Comparison of rituximab and intravenous immunoglobulin in the treatment of autoimmune bullous diseases: Real-life data from a single centre. Int J Clin Pract 2021; 75:e14955. [PMID: 34610193 DOI: 10.1111/ijcp.14955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/02/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/AIM Rituximab (RTX) and intravenous human immunoglobulin (IVIG) have been shown to be effective in the treatment of autoimmune bullous diseases (ABD), mainly pemphigus vulgaris (PV). The present study aimed to assess the clinical response of patients with ABD, mainly PV to RTX, IVIG and combined regimen of both. Whether adding IVIG to RTX therapy affects the achievement of complete remission off therapy (CR off), reduces time to CR off, time to steroid cessation, and decreases relapse rate was also investigated. METHODS Data of 33 patients with ABD [PV (93.9%)], including clinical response to treatment, steroid cessation time, time to CR off and relapse, were recruited from medical charts. RESULTS CR off and relapse rate, mean time to CR off and relapse was 86.7% (n = 13) vs 60.0% (n = 6) and 53.3% (n = 8) vs 40% (n = 4), 12.77 ± 9.30 vs 11.25 ± 13.40 and 24.1 ± 16.7 vs 13.0 ± 3.6 months in RTX and combination group, respectively. Older age (P = .005), younger age at the time of diagnosis (P = .004), lesser disease duration to the initiation of RTX (P = .004), lesser BMI (P = .026) and female gender (P = .037) were associated factors with CR off. CONCLUSION Adding IVIG to RTX did not increase CR off rates; it also did not decrease time to CR off, time to steroid cessation, relapse rates and did not increase time to relapse. Patient and disease characteristics, including age, younger age at the time of diagnosis, lesser disease duration before RTX treatment, lesser BMI and female gender, are factors associated with CR off.
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Affiliation(s)
- Leyla Huseynova Terzi
- Department of Dermatology and Venereology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Neslihan Akdogan
- Department of Dermatology and Venereology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Sibel Dogan Gunaydin
- Department of Dermatology and Venereology, School of Medicine, Hacettepe University, Ankara, Turkey
- Department of Pediatric Basic Sciences Immunology, Graduate School of Medical Sciences, Hacettepe University, Ankara, Turkey
| | - Nilgun Atakan
- Department of Dermatology and Venereology, School of Medicine, Hacettepe University, Ankara, Turkey
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16
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Lemieux A, Saber M, Côté B. Superiority of Rituximab Over Mycophenolate Mofetil in the Treatment of Pemphigus Vulgaris: A Step Further in Its Approval as a First-Line Treatment? J Cutan Med Surg 2021; 26:103-104. [PMID: 34320862 DOI: 10.1177/12034754211035098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandre Lemieux
- 25443 Department of Medicine, Service of Dermatology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Melissa Saber
- 25443 Department of Medicine, Service of Dermatology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Benoit Côté
- 25443 Department of Medicine, Service of Dermatology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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17
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Bardazzi F, Loi C, Chessa Marco A, Di Altobrando A, Filippi F, Lacava R, Viviani F, Balestri R, Leuzzi M, Sacchelli L. Therapeutic approaches and targets for treatment of autoimmune bullous diseases. Dermatol Ther 2021; 34:e15032. [PMID: 34145701 DOI: 10.1111/dth.15032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 01/22/2023]
Abstract
Autoimmune bullous diseases are a heterogeneous group of diseases characterized by the development of cutaneous and mucosal vesicles, blisters, and finally erosions. The common pathogenetic mechanism is the presence of autoantibodies targeting structural proteins of the skin and mucous membranes (demosomes and hemidesmosomes): in the case of pemphigus, the antigens are intraepidermal, whereas in the case of pemphigoid, dermatitis herpetiformis, and epidermolysis bullosa acquisita they are subepidermal. Mucosal involvement typically affects the oral and ocular mucosa, but in some cases, the upper airways or the upper digestive tract are affected. The burden on patients' lives could be severe due to the impairment of normal feeding or breathing. In other cases, they may represent paraneoplastic syndromes. Since autoimmune bullous diseases may result in significant morbidity and mortality, depending on the grade of cutaneous and mucosal involvement, a prompt therapeutic approach is mandatory and, in recalcitrant cases, may be challenging. The first line therapy consists of corticosteroids, both topical and systemic. Once remission or control of the acute phase is obtained, adjuvant therapies need to be introduced in order to spare the corticosteroid load and minimize side effects such as iatrogenic diabetes or osteoporosis. Herein, we describe all current therapeutic approaches to autoimmune bullous diseases, also including emerging therapies.
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Affiliation(s)
- Federico Bardazzi
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Camilla Loi
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Adriano Chessa Marco
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Ambra Di Altobrando
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Federica Filippi
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Rossella Lacava
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Filippo Viviani
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Riccardo Balestri
- Division of Dermatology, Rare Disease Outpatient Service, Santa Chiara Hospital, Trento, Italy
| | - Miriam Leuzzi
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
| | - Lidia Sacchelli
- Department of Specialized, Clinical and Experimental medicine, Division of Dermatology, University of Bologna, Italy
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18
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Bozca BC, Bilgiç A, Uzun S. Long-term experience with rituximab therapy for treatment-resistant moderate-to-severe pemphigus. J DERMATOL TREAT 2021; 33:2102-2109. [PMID: 34027788 DOI: 10.1080/09546634.2021.1919288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rituximab appears to be effective for treating pemphigus, although there are limited long-term data. METHODS This retrospective single-center study evaluated patients with conventional treatment-resistant pemphigus who received rituximab during September 2010-December 2019. The first rituximab cycle was based on the rheumatoid arthritis protocol in all patients except one patient, and additional single doses (500 mg or 1000 mg) were administered after clinical and/or serological relapse. The consensus definitions were used for complete remission off therapy, complete remission on minimal therapy, and clinical relapse. Serological relapse was defined as a progressive ≥2-fold increase in anti-desmoglein titers (vs. previous the measurement). RESULTS The study included 52 patients with pemphigus vulgaris and 1 patient with pemphigus foliaceus. The mean number of infusions was 5 and the average follow-up after the first infusion was 56 months. The average time to clinical and/or serological relapse was 12 months. Complete remission was achieved in 84.9% of patients, including after the first rituximab cycle in 25 patients (47.1%). Two patients died during the follow-up period. CONCLUSION Additional rituximab cycles may help achieve and prolong remission in patients with moderate-to-severe pemphigus resistant to conventional therapies. However, prospective trials are needed to identify the optimal dosing protocol.
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Affiliation(s)
- Burçin Cansu Bozca
- Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Aslı Bilgiç
- Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Soner Uzun
- Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey
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19
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Aryanian Z, Balighi K, Daneshpazhooh M, Karamshahi E, Hatami P, Goodarzi A, Tajalli M, Vance TM. Rituximab exhibits a better safety profile when used as a first line of treatment for pemphigus vulgaris: A retrospective study. Int Immunopharmacol 2021; 96:107755. [PMID: 34162136 DOI: 10.1016/j.intimp.2021.107755] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/04/2021] [Accepted: 05/01/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pemphigus is an autoimmune disease that is challenging to treat and has few available therapeutic options. Recently, several studies have demonstrated that rituximab may be an efficacious first-line treatment in newest guidelines. AIM To compare the side effect profiles of rituximab administered after a course of immunosuppressant agents versus as a first-line therapy and evaluate the impact of patient characteristics and disease severity indices on occurrence of adverse effects. METHODS A retrospective cross-sectional study was conducted on 999 patients with pemphigus vulgaris who received rituximab either as a first-line treatment or after conventional adjuvant therapies. The occurrence of partial or complete remission as well as the incidence of drug-related adverse effects were evaluated and compared between the two groups. RESULTS Smoking, pulmonary comorbidity, and mucocutaneous phenotype were associated with an increased risk of developing infectious complications by 12.49, 5.79, and 2.37 fold, respectively. These associations were more prominent among those who received rituximab after immunosuppressant agents. CONCLUSIONS Early use of rituximab benefits pemphigus patients, especially those with a mucocutaneous phenotype, pulmonary comorbidity, or history of smoking, and reduces their risk of infectious adverse events.
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Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran 1199663911, Iran; Department of Dermatology, Babol University of Medical Sciences, Babol 47176_47745, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran 1199663911, Iran; Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran 1199663911, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran 1199663911, Iran; Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran 1199663911, Iran
| | - Emad Karamshahi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran 1199663911, Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran 1199663911, Iran.
| | - Azadeh Goodarzi
- Department of Dermatology, School of Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Mahroo Tajalli
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Terrence M Vance
- Department of Epidemiology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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20
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Santamaria-Alza Y, Vasquez G. Are chimeric antigen receptor T cells (CAR-T cells) the future in immunotherapy for autoimmune diseases? Inflamm Res 2021; 70:651-663. [PMID: 34018005 DOI: 10.1007/s00011-021-01470-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE CAR-T cell therapy has revolutionized the treatment of oncological diseases, and potential uses in autoimmune diseases have recently been described. The review aims to integrate the available data on treatment with CAR-T cells, emphasizing autoimmune diseases, to determine therapeutic advances and their possible future clinical applicability in autoimmunity. MATERIALS AND METHODS A search was performed in PubMed with the keywords "Chimeric Antigen Receptor" and "CART cell". The documents of interest were selected, and a critical review of the information was carried out. RESULTS In the treatment of autoimmune diseases, in preclinical models, three different cellular strategies have been used, which include Chimeric antigen receptor T cells, Chimeric autoantibody receptor T cells, and Chimeric antigen receptor in regulatory T lymphocytes. All three types of therapy have been effective. The potential adverse effects within them, cytokine release syndrome, cellular toxicity and neurotoxicity must always be kept in mind. CONCLUSIONS Although information in humans is not yet available, preclinical models of CAR-T cells in the treatment of autoimmune diseases show promising results, so that in the future, they may become a useful and effective therapy in the treatment of these pathologies.
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Affiliation(s)
- Yeison Santamaria-Alza
- Rheumatology Section, Facultad de Medicina, Universidad de Antioquia, Street 52 number 61-30 lab 510, Medellín, Colombia.
| | - Gloria Vasquez
- Rheumatology Section, Facultad de Medicina, Universidad de Antioquia, Street 52 number 61-30 lab 510, Medellín, Colombia
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21
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Kanokrungsee S, Anuntrangsee T, Tankunakorn J, Srisuwanwattana P, Suchonwanit P, Chanprapaph K. Rituximab Therapy for Treatment of Pemphigus in Southeast Asians. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:1677-1690. [PMID: 33911853 PMCID: PMC8075311 DOI: 10.2147/dddt.s306046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/01/2021] [Indexed: 01/12/2023]
Abstract
Background Rituximab provides more effective and less adverse effects than the standard dose of corticosteroids, but evidence on its efficacy and safety in the Thai population is lacking. Objective To evaluate the efficacy and safety of rituximab in the treatment of pemphigus and also to determine prognostic factors linked to the treatment outcomes. Methods Pemphigus patients who received rituximab from November 2017 to December 2020 were retrospectively reviewed. The outcome was evaluated by using early (end of consolidation phase [ECP]) and late endpoints (complete remission [CR] on/off therapy, immunological remission [IR], and relapse). Adverse events were noted. Prognostic factors associated with remission and relapse were analyzed. Results Of 53 pemphigus patients, all attained ECP within 1.61 months. Almost 80% achieved CR on therapy within a median time of 6.36 months, while 33.9% reached CR off therapy in 19.74 months. Nearly half had IR within a median time of 6.88 months. Relapse occurred in 33.3% with a median time of 14 months. In multivariate analysis, receiving rituximab within 12 months of disease duration was more likely to achieve CR off therapy and IR (hazard ratio [HR] 3.79; 95% confidence interval [CI] 1.38, 10.42; P = 0.01 and HR 2.74; 95% CI 1.12, 6.69; P = 0.027, respectively), whereas older patients and positive anti-desmoglein 1 levels at the time of CR were predictive indicators for relapse (HR 1.07; 95% CI 1.01, 1.13; P = 0.036 and HR 4.38; 95% CI 1.24, 15.46; P = 0.022, respectively). The treatment-related adverse effects occurred in 33.9%. Conclusion Rituximab is effective and safe in Thai pemphigus patients. Early administration of rituximab was a predictor of clinical and immunological remission. Older age and persistently positive anti-Dsg1 were correlated with disease relapse.
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Affiliation(s)
- Silada Kanokrungsee
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Graduate School of Srinakharinwirot University, Bangkok, Thailand
| | - Tanaporn Anuntrangsee
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jutamas Tankunakorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ploychompoo Srisuwanwattana
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Chakri Naruebodindra Hospital, Mahidol University, Samut Prakan, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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22
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Bohelay G, Caux F, Musette P. Clinical and biological activity of rituximab in the treatment of pemphigus. Immunotherapy 2021; 13:35-53. [PMID: 33045883 DOI: 10.2217/imt-2020-0189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
B-cells are major effector cells in autoimmunity since they differentiate into plasmocytes that produce pathogenic auto-antibody such as anti-desmoglein antibodies in pemphigus patients. Major advances were obtained using whole B-cell depleting therapies including anti-CD20 antibodies in refractory pemphigus patients that lead to rituximab approval in pemphigus patients in EU and USA. This review summarizes the data supporting the efficacy of rituximab in pemphigus and provides an overview of the reported immunological changes underlying its therapeutic action. Short and long-term remission in pemphigus is explained by the removal of autoreactive B-cells involved in the production of pathogenic IgG auto-antibodies and by enhancement of the appearance of regulatory B-cells that could maintain long term immune tolerance.
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Affiliation(s)
- Gérôme Bohelay
- Department of Dermatology, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP & INSERM UMR1125, Bobigny, France
| | - Frédéric Caux
- Department of Dermatology, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP & INSERM UMR1125, Bobigny, France
| | - Philippe Musette
- Department of Dermatology, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP & INSERM UMR1125, Bobigny, France
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23
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Mignard C, Maho-Vaillant M, Golinski ML, Balayé P, Prost-Squarcioni C, Houivet E, Calbo SB, Labeille B, Picard-Dahan C, Konstantinou MP, Chaby G, Richard MA, Bouaziz JD, Duvert-Lehembre S, Delaporte E, Bernard P, Caux F, Alexandre M, Ingen-Housz-Oro S, Vabres P, Quereux G, Dupuy A, Debarbieux S, Avenel-Audran M, D'Incan M, Bédane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Benichou J, Joly P, Hébert V. Factors Associated With Short-term Relapse in Patients With Pemphigus Who Receive Rituximab as First-line Therapy: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Dermatol 2020; 156:545-552. [PMID: 32186656 DOI: 10.1001/jamadermatol.2020.0290] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Rituximab and short-term corticosteroid therapy are the criterion standard treatments for patients with newly diagnosed moderate to severe pemphigus. Objective To examine factors associated with short-term relapse in patients with pemphigus treated with rituximab. Design, Setting, and Participants This post hoc analysis of a randomized clinical trial (Comparison Between Rituximab Treatment and Oral Corticosteroid Treatment in Patients With Pemphigus [RITUX 3]) conducted from January 1, 2010, to December 31, 2015, included patients from 20 dermatology departments of tertiary care centers in France from the RITUX 3 trial and 3 newly diagnosed patients treated according to the trial protocol. Data analysis was performed from February 1 to June 30, 2019. Exposure Patients randomly assigned to the rituximab group in the RITUX 3 trial and the 3 additional patients were treated with 1000 mg of intravenous rituximab on days 0 and 14 and 500 mg at months 12 and 18 combined with a short-term prednisone regimen. Main Outcomes and Measures Baseline (pretreatment) clinical and biological characteristics (Pemphigus Disease Area Index [PDAI] score, ranging from 0-250 points, with higher values indicating more severe disease) and changes in anti-desmoglein (DSG) 1 and anti-DSG3 values as measured by enzyme-linked immunosorbent assay during the 3 months after rituximab treatment were compared between patients with disease relapse and those who maintained clinical remission during the first 12 months after treatment. The positive and negative predictive values of these factors were calculated. Results Among 47 patients (mean [SD] age, 54.3 [17.0] years; 17 [36%] male and 30 [64%] female) included in the study, the mean (SD) baseline PDAI score for patients with relapsing disease was higher than that of the patients with nonrelapsing disease (54 [33] vs 28 [24]; P = .03). At month 3, 7 of 11 patients with relapsing disease (64%) vs 7 of 36 patients with nonrelapsing disease (19%) had persistent anti-DSG1 antibody values of 20 IU/mL or higher and/or anti-DSG3 antibody values of 130 IU/mL or higher (P = .01). A PDAI score of 45 or higher defining severe pemphigus and/or persistent anti-DSG1 antibody values of 20 IU/mL or higher and/or anti-DSG3 antibody values of 130 IU/mL or higher at month 3 provided a positive predictive value of 50% (95% CI, 27%-73%) and a negative predictive value of 94% (95% CI, 73%-100%) for the occurrence of relapse after rituximab. Conclusions and Relevance The findings suggest that initial PDAI score and changes in anti-DSG antibody values after the initial cycle of rituximab might help differentiate a subgroup of patients with high risk of relapse who might benefit from maintenance rituximab infusion at month 6 from a subgroup of patients with low risk of relapse who do not need early maintenance therapy. Trial Registration NCT00784589.
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Affiliation(s)
- Claire Mignard
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Maud Maho-Vaillant
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Marie-Laure Golinski
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Pierre Balayé
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France
| | - Catherine Prost-Squarcioni
- Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Department of Dermatology, University of Paris 13, Bobigny, France
| | - Estelle Houivet
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France
| | - Sé Bastien Calbo
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint Etienne, Saint Etienne, France
| | | | | | - Guillaume Chaby
- Department of Dermatology, University of Amiens, Amiens, France
| | - Marie-Aleth Richard
- Assistance Publique des Hôpitaux de Marseille, Department of Dermatology, Aix Marseille University, UMR 911, INSERM CRO2, Marseille, France
| | - Jean-David Bouaziz
- Department of Dermatology, St Louis Hospital, Paris 7 Sorbonne Paris Cité University, Paris, France
| | | | | | | | - Frédéric Caux
- Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Department of Dermatology, University of Paris 13, Bobigny, France
| | - Marina Alexandre
- Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Department of Dermatology, University of Paris 13, Bobigny, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Pierre Vabres
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - Gaëlle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | - Sébastien Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Michel D'Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nathalie Bénéton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Lyon Claude Bernard University, Lyon, France
| | - Nicolas Dupin
- Department of Dermatology, University of Paris V, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | | | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Bruno Sassolas
- Department of Internal Medicine, Brest University Hospital, Brest, France
| | - Jacques Benichou
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France
| | - Pascal Joly
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Vivien Hébert
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
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Abstract
Pemphigus is a rare autoimmune disease of the skin, characterized by autoantibodies targeting adhesion proteins of the epidermis, in particular desmoglein 3 and desmoglein 1, that cause the loss of cell-cell adhesion and the formation of intraepidermal blisters. Given that these autoantibodies are both necessary and sufficient for pemphigus to occur, the goal of pemphigus therapy is the elimination of autoreactive B-cells responsible for autoantibody production. Rituximab, an anti-CD20 monoclonal antibody, was the first targeted B-cell therapy approved for use in pemphigus and is now considered the frontline therapy for new onset disease. One limitation of this treatment is that it targets both autoreactive and non -autoreactive B-cells, which accounts for the increased risk of serious infections in treated patients. In addition, most rituximab-treated patients experience disease relapse, highlighting the need of new therapeutic options. This review provides a concise overview of rituximab use in pemphigus and discusses new B-cell and antibody-directed therapies undergoing investigation in clinical studies.
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Affiliation(s)
- Roberto Maglie
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy -
| | - Emiliano Antiga
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Aimee S Payne
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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25
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Shimanovich I, Baumann T, Schmidt E, Zillikens D, Hammers CM. Long-term outcomes of rituximab therapy in pemphigus. J Eur Acad Dermatol Venereol 2020; 34:2884-2889. [PMID: 32367562 DOI: 10.1111/jdv.16561] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/15/2020] [Accepted: 04/07/2020] [Indexed: 12/11/2022]
Abstract
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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Affiliation(s)
- I Shimanovich
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - T Baumann
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - C M Hammers
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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26
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Kianfar N, Dasdar S, Mahmoudi H, Tavakolpour S, Balighi K, Daneshpazhooh M. Rituximab in childhood and juvenile autoimmune bullous diseases as first-line and second-line treatment: a case series of 13 patients. J DERMATOL TREAT 2020; 33:869-874. [DOI: 10.1080/09546634.2020.1788702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nika Kianfar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Dasdar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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27
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Russo I, Miotto S, Saponeri A, Alaibac M. Ultra-low dose rituximab for refractory pemghigus vulgaris: a pilot study. Expert Opin Biol Ther 2020; 20:673-678. [PMID: 32027810 DOI: 10.1080/14712598.2020.1727440] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Pemphigus vulgaris is an autoimmune blistering disease affecting the skin and mucous membranes. Current treatments for pemphigus vulgaris include anti-inflammatory and immunosuppressive agents. Rituximab, an anti-CD20 monoclonal antibody, has been shown to be effective for the treatment of pemphigus vulgaris. However, the optimal dosage of rituximab for the treatment of this autoimmune bullous disease has not been clearly defined.The aim of this study was to investigate the clinical efficacy and adverse effects of an ultra-low dosage regimen of rituximab for pemphigus vulgaris.Methods: We performed a prospective non-randomized open case series including eight patients affected by pemphigus vulgaris. Patients were treated with an ultra-low dosage of rituximab (a single infusion of 200 mg).Results: All patients had a positive response after infusion. At the end of the follow-up period, 5 patients achieved a complete remission and 3 a partial remission. Except for one case of sepsis due to Citrobacer freundii and a pneumonia due to Haemophilus influenzae, no adverse events were documented in our patients.Conclusions: Data from our study suggest that an ultra-low dosage of rituximab could be an effective treatment for pemphigus vulgaris. Consequently, there is a need for a larger, confirmatory, randomized, multicenter trial.
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Affiliation(s)
- Irene Russo
- Unit of Dermatology, University of Padua, Padua, Italy
| | - Serena Miotto
- Unit of Dermatology, University of Padua, Padua, Italy
| | | | - Mauro Alaibac
- Unit of Dermatology, University of Padua, Padua, Italy
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28
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Abstract
Rituximab (MabThera®, Rituxan®), a chimeric murine/human anti-CD20 monoclonal antibody administered by intravenous infusion, is indicated for the treatment of moderate to severe pemphigus vulgaris (PV), in combination with a tapering course of corticosteroids. Approval in the EU and USA was based on data for the subset of patients with newly-diagnosed, previously untreated PV participating in the randomized, controlled RITUX 3 study; rituximab plus short-course prednisone resulted in a > 3-fold higher rate of complete remission off prednisone therapy and a > 2-fold decrease in the rate of moderate/severe relapse compared with standard-dose prednisone in this patient subpopulation. In addition, rituximab plus short-term prednisone was steroid-sparing and resulted in fewer patients experiencing grade 3 or 4 corticosteroid-related adverse events compared with standard-dose prednisone. The adverse event profile of rituximab in patients with PV was consistent with that observed for the drug in other approved autoimmune disorders; no new safety concerns were identified. Notwithstanding there is some uncertainty over the optimum dosing schedule to achieve and maintain disease control, rituximab is a highly effective and generally well tolerated, steroid-sparing treatment for moderate to severe PV.
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Affiliation(s)
- James E Frampton
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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29
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Barroil M, Girard C, Lerisson M, Negroni V, Bertrand AS, Pallure V, Bessis D, Guillot B, Dereure O. [Use of rituximab in maintenance treatment of pemphigus: A retrospective series]. Ann Dermatol Venereol 2020; 147:173-178. [PMID: 31955970 DOI: 10.1016/j.annder.2019.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/31/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Rituximab (RTX), currently recommended as first-line treatment in moderate to severe pemphigus vulgaris (PV) and superficial pemphigus (PS) along with initial systemic steroids, may also be used as second-line or subsequent treatment, and this therapeutic strategy was investigated in a real-life monocentre retrospective survey. MATERIAL AND METHODS All patients treated between January 2010 and March 2018 with RTX as second-line or subsequent treatment for moderate to severe PV or PS and followed for at least one year were included. The main objective was to evaluate rates and times of complete clinical remission (CCR) after a first course of RTX. The secondary objectives consisted mainly of treatment safety, and frequency and time to relapse after the initial CCR. RESULTS The 24 patients selected received on average 2 cycles of RTX (i.e. 24 initial cycles and 24 additional cycles in all) over a mean follow-up period of 45 months. 18/24 (75%) patients achieved initial CCR within a mean 7.7 months. Despite at least one relapse in 13/18 initially responding patients regardless of relapse time, 59% (14/24) and 33% (8/24) were either in CCR and off treatment, or in partial remission, whether treated or untreated, according to the latest patient news, with an overall response rate of 92%. Safety was fair in these fragile patients. DISCUSSION AND CONCLUSION This survey of the practical use of RTX confirms its interest in moderate to severe pemphigus as a second-line or subsequent treatment, a situation that probably remains relevant even if this molecule is increasingly used as first-line therapy.
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Affiliation(s)
- M Barroil
- Département de Dermatologie et INSERM U1058 « pathogénèse et contrôle des infections chroniques », université de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, Montpellier cedex 5, France
| | - C Girard
- Département de Dermatologie et INSERM U1058 « pathogénèse et contrôle des infections chroniques », université de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, Montpellier cedex 5, France
| | - M Lerisson
- Département de Dermatologie et INSERM U1058 « pathogénèse et contrôle des infections chroniques », université de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, Montpellier cedex 5, France
| | - V Negroni
- Département de Dermatologie et INSERM U1058 « pathogénèse et contrôle des infections chroniques », université de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, Montpellier cedex 5, France
| | - A-S Bertrand
- Département de Dermatologie et INSERM U1058 « pathogénèse et contrôle des infections chroniques », université de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, Montpellier cedex 5, France
| | - V Pallure
- Département de Dermatologie et INSERM U1058 « pathogénèse et contrôle des infections chroniques », université de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, Montpellier cedex 5, France
| | - D Bessis
- Département de Dermatologie et INSERM U1058 « pathogénèse et contrôle des infections chroniques », université de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, Montpellier cedex 5, France
| | - B Guillot
- Département de Dermatologie et INSERM U1058 « pathogénèse et contrôle des infections chroniques », université de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, Montpellier cedex 5, France
| | - O Dereure
- Département de Dermatologie et INSERM U1058 « pathogénèse et contrôle des infections chroniques », université de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, Montpellier cedex 5, France.
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30
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Sharma VK, Gupta V, Bhari N, Singh V. Rituximab as an adjuvant therapy for pemphigus: experience in 61 patients from a single center with long-term follow-up. Int J Dermatol 2020; 59:76-81. [PMID: 31257579 DOI: 10.1111/ijd.14546] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Rituximab is increasingly being used as an adjuvant treatment for recalcitrant or relapsed pemphigus, but information on its use as a first-line agent is limited. We describe the long-term effectiveness and safety of rituximab in the treatment of pemphigus and compare the treatment outcomes when rituximab is used as first-line treatment vis-à-vis after treatment failure or relapse. METHODS This was a retrospective review of 61 patients with pemphigus treated with rituximab at our center from March 2012 to October 2018. RESULTS Of the 61 patients, 51 achieved complete remission (on or off treatment) and 10 had partial remission. Forty-nine (80.33%) patients achieved complete remission off prednisolone over a mean period of 8.08 ± 4.45 (range 3-20) months. Seventeen (27.9%) patients relapsed after a mean period of 23.94 ± 13.15 months after first rituximab cycle and 15.97 + 13.7 months after stopping prednisolone. Treatment-related serious adverse effects were noted in six (9.8%) patients. Eighteen (29.5%) patients were administered rituximab as the first-line adjuvant, while 43 (70.5%) patients received it after treatment failure or relapse. In both groups, remission rates on prednisolone (88.9%, 81.4%) and off prednisolone (88.9%, 76.7%) were comparable (P > 0.05). Relapse rates in the group which received rituximab as first-line treatment were about half of those who received rituximab after relapse or treatment failure (16.7% vs. 32.6%, P = 0.348). No statistically significant difference was seen in the times to different treatment endpoints (disease control, complete remission on and off prednisolone, and relapse) between the two groups. CONCLUSIONS Rituximab is a safe and effective adjuvant in the treatment of pemphigus. Treatment outcomes were better for patients who received rituximab as first-line treatment, but the difference was not statistically significant.
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Affiliation(s)
- Vinod K Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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31
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Yanovsky RL, McLeod M, Ahmed AR. Treatment of pemphigus vulgaris: part 2 - emerging therapies. Expert Rev Clin Immunol 2019; 15:1061-1071. [PMID: 31575295 DOI: 10.1080/1744666x.2020.1672539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Corticosteroids and immunosuppressive agents have been the mainstay for the treatment of pemphigus vulgaris (PV). While they have benefited patients, they have been associated with the risks of prolonged immune suppression and a high incidence of significant and catastrophic side effects. Relapses are common. Novel agents promising targeted therapies, that may provide better outcomes, are being studied. Areas covered: Recently rituximab with corticosteroids has been recommended as the first-line treatment for PV. A number of known and new therapeutic agents currently investigated are BAFF, P13K, BTK inhibitors along with the use of IVIg and CAR-T therapy. The possible role of these therapeutic targets in the pathophysiology appears to be the rationale for the treatment of this potentially fatal disease. Expert opinion: While there is significant enthusiasm for these therapies, certain concerns and consequences are being under-discussed. None of the current clinical trials in progress are specific for PV, except possibly CAR-T therapy. The major issue(s) that are unclear is whether these therapies would be successful in providing long-term clinical remissions. Will these therapies require additional agents to be effective? Will the benefits be limited in duration? The answers to many questions will determine their final place in the algorithm for the treatment of PV.
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Affiliation(s)
| | - Michael McLeod
- Department of Dermatology, Tufts Medical Center , Boston , MA , USA
| | - A Razzaque Ahmed
- Department of Dermatology, Tufts Medical Center , Boston , MA , USA.,Center for Blistering Diseases , Boston , MA , USA
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32
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Laftah Z, Craythorne E, Mufti GJ, du Vivier A. Clinical efficacy of rituximab in the treatment of pemphigus vulgaris: A 10-year follow-up. J Oral Pathol Med 2019; 48:861-862. [PMID: 31408552 DOI: 10.1111/jop.12948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zainab Laftah
- Department of Dermatology, King's College Hospital, London, UK
| | - Emma Craythorne
- Department of Dermatology, St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - Ghulam J Mufti
- Department of Haematological medicine, King's College Hospital, London, UK
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33
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Porro AM, Seque CA, Ferreira MCC, Enokihara MMSES. Pemphigus vulgaris. An Bras Dermatol 2019; 94:264-278. [PMID: 31365654 PMCID: PMC6668932 DOI: 10.1590/abd1806-4841.20199011] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/02/2019] [Indexed: 12/11/2022] Open
Abstract
Pemphigus vulgaris is a chronic autoimmune bullous dermatosis that results from the production of autoantibodies against desmogleins 1 and 3. It is the most frequent and most severe form of pemphigus, occurring universally, usually between 40 and 60 years of age. It usually begins with blisters and erosions on the oral mucosa, followed by lesions on other mucous membranes and flaccid blisters on the skin, which can be disseminated. There is a clinical variant, pemphigus vegetans, which is characterized by the presence of vegetating lesions in the large folds of the skin. Clinical suspicion can be confirmed by cytological examination, histopathological examination, and direct and indirect immunofluorescence tests. The treatment is performed with systemic corticosteroids, and immunosuppressive drugs may be associated, among them azathioprine and mycophenolate mofetil. More severe cases may benefit from corticosteroids in the form of intravenous pulse therapy, and recent studies have shown a beneficial effect of rituximab, an anti-CD20 immunobiological drug. It is a chronic disease with mortality around 10%, and septicemia is the main cause of death. Patients need long-term and multidisciplinary follow-up.
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Affiliation(s)
- Adriana Maria Porro
- Department of Dermatology, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Camila Arai Seque
- Department of Dermatology, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Didona D, Maglie R, Eming R, Hertl M. Pemphigus: Current and Future Therapeutic Strategies. Front Immunol 2019; 10:1418. [PMID: 31293582 PMCID: PMC6603181 DOI: 10.3389/fimmu.2019.01418] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022] Open
Abstract
Pemphigus encompasses a heterogeneous group of autoimmune blistering diseases, which affect both mucous membranes and the skin. The disease usually runs a chronic-relapsing course, with a potentially devastating impact on the patients' quality of life. Pemphigus pathogenesis is related to IgG autoantibodies targeting various adhesion molecules in the epidermis, including desmoglein (Dsg) 1 and 3, major components of desmosomes. The pathogenic relevance of such autoantibodies has been largely demonstrated experimentally. IgG autoantibody binding to Dsg results in loss of epidermal keratinocyte adhesion, a phenomenon referred to as acantholysis. This in turn causes intra-epidermal blistering and the clinical appearance of flaccid blisters and erosions at involved sites. Since the advent of glucocorticoids, the overall prognosis of pemphigus has largely improved. However, mortality persists elevated, since long-term use of high dose corticosteroids and adjuvant steroid-sparing immunosuppressants portend a high risk of serious adverse events, especially infections. Recently, rituximab, a chimeric anti CD20 monoclonal antibody which induces B-cell depletion, has been shown to improve patients' survival, as early rituximab use results in higher disease remission rates, long term clinical response and faster prednisone tapering compared to conventional immunosuppressive therapies, leading to its approval as a first line therapy in pemphigus. Other anti B-cell therapies targeting B-cell receptor or downstream molecules are currently tried in clinical studies. More intriguingly, a preliminary study in a preclinical mouse model of pemphigus has shown promise regarding future therapeutic application of Chimeric Autoantibody Receptor T-cells engineered using Dsg domains to selectively target autoreactive B-cells. Conversely, previous studies from our group have demonstrated that B-cell depletion in pemphigus resulted in secondary impairment of T-cell function; this may account for the observed long-term remission following B-cell recovery in rituximab treated patients. Likewise, our data support the critical role of Dsg-specific T-cell clones in orchestrating the inflammatory response and B-cell activation in pemphigus. Monitoring autoreactive T-cells in patients may indeed provide further information on the role of these cells, and would be the starting point for designating therapies aimed at restoring the lost immune tolerance against Dsg. The present review focuses on current advances, unmet challenges and future perspectives of pemphigus management.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Roberto Maglie
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany.,Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy.,Section of Dermatology, Departement of Health Sciences, University of Florence, Florence, Italy
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
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Porro AM, Hans Filho G, Santi CG. Consensus on the treatment of autoimmune bullous dermatoses: pemphigus vulgaris and pemphigus foliaceus - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:20-32. [PMID: 31166407 PMCID: PMC6544031 DOI: 10.1590/abd1806-4841.2019940206] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/30/2019] [Indexed: 02/08/2023] Open
Abstract
Pemphigus are intraepidermal autoimmune bullous dermatoses that occur with
lesions on the skin and / or mucous membranes. The most frequent types are
pemphigus vulgaris and pemphigus foliaceus (classic and endemic). This consensus
aims to present a complete and updated review of the treatment of these two more
frequent forms of pemphigus, based on the literature and the personal experience
of the authors. In moderate and severe cases of pemphigus vulgaris and
foliaceus, systemic corticosteroid therapy (prednisone or prednisolone) is the
treatment of choice. Adjuvant drugs, usually immunosuppressive drugs
(azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide) may be
prescribed as corticosteroid sparers in refractory cases or with
contraindications to corticosteroids to minimize side effects. In severe and
nonresponsive cases, corticosteroids in the form of intravenous pulse therapy,
immunoglobulin and plasmapheresis / immunoadsorption can be administered.
Immunobiological drugs, particularly rituximab, appear as a promising
alternative. For milder cases, smaller doses of oral corticosteroid, dapsone and
topical corticosteroids are options. At the end flowcharts are presented as
suggestions for a therapeutic approach for patients with pemphigus vulgaris and
pemphigus foliaceus.
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Affiliation(s)
- Adriana Maria Porro
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Günter Hans Filho
- Dermatology Service, Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Claudia Giuli Santi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Toosi R, Mahmoudi H, Balighi K, Teimourpour A, Alaeen H, Shaghaghi M, Abedini R, Daneshpazhooh M. Efficacy and safety of biosimilar rituximab in patients with pemphigus vulgaris: a prospective observational study. J DERMATOL TREAT 2019; 32:33-40. [DOI: 10.1080/09546634.2019.1617831] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Roja Toosi
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Teimourpour
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoorieh Alaeen
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Robabeh Abedini
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Sanchez J, Ingen-Housz-Oro S, Chosidow O, Antonicelli F, Bernard P. Rituximab as Single Long-term Maintenance Therapy in Patients With Difficult-to-Treat Pemphigus. JAMA Dermatol 2019; 154:363-365. [PMID: 29299590 DOI: 10.1001/jamadermatol.2017.5176] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Julia Sanchez
- Department of Dermatology, Reims University Hospital, Reims, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique des Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.,Epidemiology in Dermatology and Evaluation of Therapeutics, Unit 7379, University Paris Est, Créteil, France
| | - Olivier Chosidow
- Department of Dermatology, Assistance Publique des Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.,Epidemiology in Dermatology and Evaluation of Therapeutics, Unit 7379, University Paris Est, Créteil, France
| | - Frank Antonicelli
- Laboratory of Dermatology, Unit 7319, University of Reims Champagne-Ardenne, Reims, France
| | - Philippe Bernard
- Department of Dermatology, Reims University Hospital, Reims, France.,Laboratory of Dermatology, Unit 7319, University of Reims Champagne-Ardenne, Reims, France
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Jelti L, Prost-Squarcioni C, Ingen-Housz-Oro S, Caux F, Bernard P, Bedane C, Alexandre M, Dereure O, Quereux G, Le Bidre E, Plée J, Picard-Dahan C, Le Roux-Villet C, Duvert-Lehembre S, Richard MA, Delaporte E, Debarbieux S, Jullien D, D'Incan M, Konstantinou MP, Bouaziz JD, Tancrède-Bohin E, Doutre MS, Bourgault Villada I, Cordel N, Sassolas B, Viguier MA, Mellottée B, Jouen F, Hebert V, Joly P. [Update of the French recommendations for the management of pemphigus]. Ann Dermatol Venereol 2019; 146:279-286. [PMID: 30929874 DOI: 10.1016/j.annder.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/24/2018] [Accepted: 01/23/2019] [Indexed: 01/29/2023]
Affiliation(s)
- L Jelti
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France.
| | - C Prost-Squarcioni
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - F Caux
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - P Bernard
- Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France
| | - C Bedane
- Service de dermatologie, hôpital Dupuytren, 87042 Limoges, France
| | - M Alexandre
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - O Dereure
- Service de dermatologie, Inserm U1058, université de Montpellier, hôpital St-Eloi, 34295 Montpellier, France
| | - G Quereux
- Service de dermatologie, CHU Hôtel-Dieu, 44093 Nantes, France
| | - E Le Bidre
- Service de dermatologie, hôpital Trousseau, CHRU de Tours, 37044 Tours, France
| | - J Plée
- Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France
| | - C Picard-Dahan
- Service de dermatologie, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France
| | - C Le Roux-Villet
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - S Duvert-Lehembre
- Service de dermatologie, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille, France
| | - M-A Richard
- EA3279 : CEReSS-centre d'étude et de recherche sur les services de santé et la qualité de vie, service de dermatologie, université Aix-Marseille, hôpital de La Timone, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France
| | - E Delaporte
- Service de dermatologie, université Aix-Marseille, hôpital Nord, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France
| | - S Debarbieux
- Service de dermatologie, hôpital Edouard-Herriot, hospices civils de Lyon, 69437 Lyon, France
| | - D Jullien
- Service de dermatologie, hôpital Edouard-Herriot, hospices civils de Lyon, 69437 Lyon, France
| | - M D'Incan
- Service de dermatologie, CHU Estaing, 63000 Clermont-Ferrand, France
| | - M-P Konstantinou
- Service de dermatologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse, France
| | - J-D Bouaziz
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - E Tancrède-Bohin
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - M-S Doutre
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France
| | - I Bourgault Villada
- Service de dermatologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - N Cordel
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France; Unité de dermatologie-immunologie clinique, CHU de Guadeloupe, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - B Sassolas
- Service de médecine interne et pneumologie, hôpital de la Cavale-Blanche, CHRU de Brest, 29609 Brest, France
| | - M-A Viguier
- Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France
| | - B Mellottée
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - F Jouen
- Inserm U1234, laboratoire d'immunologie, université de Normandie, CHU de Rouen, 76000 Rouen, France
| | - V Hebert
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France
| | - P Joly
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France
| | -
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France; Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France; Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France; Service de dermatologie, hôpital Dupuytren, 87042 Limoges, France; Service de dermatologie, Inserm U1058, université de Montpellier, hôpital St-Eloi, 34295 Montpellier, France; Service de dermatologie, CHU Hôtel-Dieu, 44093 Nantes, France; Service de dermatologie, hôpital Trousseau, CHRU de Tours, 37044 Tours, France; Service de dermatologie, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Service de dermatologie, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille, France; EA3279 : CEReSS-centre d'étude et de recherche sur les services de santé et la qualité de vie, service de dermatologie, université Aix-Marseille, hôpital de La Timone, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France; Service de dermatologie, université Aix-Marseille, hôpital Nord, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France; Service de dermatologie, hôpital Edouard-Herriot, hospices civils de Lyon, 69437 Lyon, France; Service de dermatologie, CHU Estaing, 63000 Clermont-Ferrand, France; Service de dermatologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse, France; Service de dermatologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France; Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France; Service de dermatologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Unité de dermatologie-immunologie clinique, CHU de Guadeloupe, 97159 Pointe-à-Pitre cedex, Guadeloupe; Service de médecine interne et pneumologie, hôpital de la Cavale-Blanche, CHRU de Brest, 29609 Brest, France; Inserm U1234, laboratoire d'immunologie, université de Normandie, CHU de Rouen, 76000 Rouen, France
| | -
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France; Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France; Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France; Service de dermatologie, hôpital Dupuytren, 87042 Limoges, France; Service de dermatologie, Inserm U1058, université de Montpellier, hôpital St-Eloi, 34295 Montpellier, France; Service de dermatologie, CHU Hôtel-Dieu, 44093 Nantes, France; Service de dermatologie, hôpital Trousseau, CHRU de Tours, 37044 Tours, France; Service de dermatologie, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Service de dermatologie, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille, France; EA3279 : CEReSS-centre d'étude et de recherche sur les services de santé et la qualité de vie, service de dermatologie, université Aix-Marseille, hôpital de La Timone, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France; Service de dermatologie, université Aix-Marseille, hôpital Nord, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France; Service de dermatologie, hôpital Edouard-Herriot, hospices civils de Lyon, 69437 Lyon, France; Service de dermatologie, CHU Estaing, 63000 Clermont-Ferrand, France; Service de dermatologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse, France; Service de dermatologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France; Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France; Service de dermatologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Unité de dermatologie-immunologie clinique, CHU de Guadeloupe, 97159 Pointe-à-Pitre cedex, Guadeloupe; Service de médecine interne et pneumologie, hôpital de la Cavale-Blanche, CHRU de Brest, 29609 Brest, France; Inserm U1234, laboratoire d'immunologie, université de Normandie, CHU de Rouen, 76000 Rouen, France
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Kurihara Y, Yamagami J, Funakoshi T, Ishii M, Miyamoto J, Fujio Y, Kakuta R, Tanikawa A, Aoyama Y, Iwatsuki K, Ishii N, Hashimoto T, Nishie W, Shimizu H, Kouyama K, Amagai M. Rituximab therapy for refractory autoimmune bullous diseases: A multicenter, open-label, single-arm, phase 1/2 study on 10 Japanese patients. J Dermatol 2018; 46:124-130. [PMID: 30585649 DOI: 10.1111/1346-8138.14732] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022]
Abstract
This was a multicenter study of rituximab, a chimeric monoclonal immunoglobulin G antibody directed against CD20, for the treatment of refractory autoimmune bullous diseases (pemphigus and pemphigoid). Ten patients (three with pemphigus vulgaris, six with pemphigus foliaceus and one with bullous pemphigoid) were treated with a single cycle of rituximab (four weekly infusions at a dose of 375 mg/m2 of body surface area). The primary end-points were the number of serious adverse events and rate of complete remission at 40 weeks. Five patients (50%) achieved complete remission with minimal therapy (defined as no active lesions with lower doses of systemic corticosteroids compared to that with prednisolone 10 mg/day). Improvements in clinical scores (Pemphigus Disease Area Index) and decreases in autoantibody titers in the sera were observed in the four pemphigus patients who failed to achieve complete remission. This suggests that rituximab was effective in nine of 10 cases. Two serious adverse events (Pneumocystis carinii pneumonia and septic shock due to infectious arthritis) were observed and adequately treated with hospitalization. CD19-positive B lymphocytes in the peripheral blood decreased on day 29 following rituximab treatment, and remained at low levels throughout the observation period (280 days). Our results confirmed the efficacy of rituximab therapy for refractory autoimmune bullous diseases in Japan.
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Affiliation(s)
- Yuichi Kurihara
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Maki Ishii
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Julia Miyamoto
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yumi Fujio
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Risa Kakuta
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Tanikawa
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yumi Aoyama
- Department of Dermatology, Okayama University School of Medicine, Okayama, Japan.,Department of dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Keiji Iwatsuki
- Department of Dermatology, Okayama University School of Medicine, Okayama, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Wataru Nishie
- Department of Dermatology, Hokkaido University School of Medicine, Sapporo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University School of Medicine, Sapporo, Japan
| | - Keisuke Kouyama
- Clinical and Translational Research Center, Keio University Hospital and Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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40
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Solomon SR, Sizemore CA, Ridgeway M, Zhang X, Brown S, Holland HK, Morris LE, Solh M, Bashey A. Safety and efficacy of rituximab-based first line treatment of chronic GVHD. Bone Marrow Transplant 2018; 54:1218-1226. [PMID: 30518977 DOI: 10.1038/s41409-018-0399-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/22/2018] [Accepted: 11/08/2018] [Indexed: 11/09/2022]
Abstract
Initial therapy of chronic GVHD (cGvHD) has not changed for over three decades, despite limited efficacy and long-term toxicity. We have previously shown in a small pilot study the feasibility of rituximab-based first-line therapy of cGVHD. To better assess safety and efficacy, we now evaluate 69 patients that received rituximab as part of their initial treatment. Median follow-up for surviving patients was 47 (11-81) months. Resolution of cGVHD occurred in 49 patients with median time to IST discontinuation of 349 (138-920) days. The cumulative incidence (CI) of cGHVD resolution was 41%, 69 and 77% at 1-, 2- and 3-years, respectively. No systemic corticosteroids were used in 27 patients, and 67% received ≤ 10 mg/kg cumulative exposure. Overall survival (OS) at 1-, 2- and 3-years following cGVHD diagnosis was 87, 79 and 77% respectively; corresponding rates of non-relapse mortality (NRM) were 10%, 16 and 19%. The probability of being alive and free of cGVHD at 1-, 2-, and 3-years was 36, 55, and 57% respectively. This study demonstrates the feasibility and efficacy of rituximab-based first-line cGVHD treatment. This approach demonstrates significant activity and avoids long courses of corticosteroids in most patients.
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Affiliation(s)
- Scott R Solomon
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA.
| | - Connie A Sizemore
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Michelle Ridgeway
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Xu Zhang
- The University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Stacey Brown
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - H Kent Holland
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Lawrence E Morris
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Asad Bashey
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
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41
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Comparing early and late treatments with rituximab in pemphigus vulgaris: which one is better? Arch Dermatol Res 2018; 311:63-69. [DOI: 10.1007/s00403-018-1881-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/06/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
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Overton M, Culton D. Autoimmune Blistering Disorders in the Geriatric Population. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0265-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Comparison of rituximab and conventional adjuvant therapy for pemphigus vulgaris: A retrospective analysis. PLoS One 2018; 13:e0198074. [PMID: 30252855 PMCID: PMC6155499 DOI: 10.1371/journal.pone.0198074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/13/2018] [Indexed: 02/08/2023] Open
Abstract
Background Rituximab is a promising steroid sparing agent used in the treatment of moderate to severe pemphigus vulgaris. Its exact place in the algorithm of pemphigus treatment, vis-à-vis other, conventional adjuvant therapy (CAT) is not known. Objective To describe and compare disease course outcomes and morbidity among patients with moderate to severe pemphigus who received rituximab therapy (RT) in addition to prednisone and CAT, versus those who were treated with prednisone and CAT alone. Methods A 16-year retrospective case control study was designed with adult patients who were seen at the Duke University Dermatology Immunodermatology clinic from 1999–2015, who had a diagnosis of pemphigus vulgaris, and required prednisone and at least 1 systemic CAT. All patients had at least 6 months follow up from the initial visit. Interventions included RT, systemic CAT, and prednisone. The main outcome measured was prednisone intake. Secondary outcomes were complete remission (CR) and partial remission (PR). Results 40 patients were included in the study. All initially received prednisone and at least 1 systemic CAT. 13/40 eventually went on to receive RT, while 27/40 remained on CAT (CAT-only). Patients in the RT group, pre-RT, had a median prednisone intake of 658.57 mg/month. Rituximab treatment significantly reduced this to 177.22 mg/month (p = 0.002). Median prednisone intake of the CAT-only group was 141.33 mg/month. This was significantly less than Pre-RT (p = 0.01) and on par with Post-RT intake (p = 0.58). 54% of patients in the RT group and 64% of those in the CAT-only group achieved CR. All patients in the RT group and 96% of those in the CAT-only group achieved at least PR. Conclusions 32.5% of our patients with moderate to severe pemphigus vulgaris failed prednisone and traditional CAT treatment and required rituximab therapy. Rituximab reduced the monthly prednisone intake in these patients by 73%. This suggests that a subset of patients with moderate to severe pemphigus may benefit from early institution of rituximab therapy. Rituximab significantly reduces the monthly prednisone requirement among CAT-resistant pemphigus vulgaris patients to levels on par with CAT-responsive patients.
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Balighi K, Daneshpazhooh M, Akbari Z, Tavakolpour S, Azimi P, Azizpour A. Comparing the short-term therapeutic effects and safety profiles of rituximab therapy in pemphigus vulgaris patients either early treated or later than six months. J DERMATOL TREAT 2018; 30:346-349. [DOI: 10.1080/09546634.2018.1509049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kamran Balighi
- Department of Dermatology, Razi Hospital, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Razi Hospital, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Akbari
- Department of Dermatology, Razi Hospital, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pourya Azimi
- Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arghavan Azizpour
- Department of Dermatology, Razi Hospital, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Pemphigus and pemphigoid are characterized as autoimmune blistering diseases in which immunoglobulin G autoantibodies cause blisters and erosions of the skin or mucosa or both. Recently, understanding of the pathophysiology of pemphigus and pemphigoid has been furthered by genetic analyses, characterization of autoantibodies and autoreactive B cells, and elucidation of cell–cell adhesion between keratinocytes. For the management of pemphigus and pemphigoid, the administration of systemic corticosteroids still represents the standard treatment strategy; however, evidence of the efficacy of therapies not involving corticosteroids, such as those employing anti-CD20 antibodies, is increasing. The goal should be to develop antigen-specific immune suppression-based treatments.
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Affiliation(s)
- Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Hamadah I, Chisti MA, Haider M, Binamer Y, Alajlan S, Aleyouni Y, Alfadley A. Rituximab/IVIG in pemphigus – a 10-year study with a long follow-up. J DERMATOL TREAT 2018; 30:170-175. [DOI: 10.1080/09546634.2018.1484873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Issam Hamadah
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Muzamil A. Chisti
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Mansoor Haider
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Yousef Binamer
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Saad Alajlan
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Yousif Aleyouni
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Alfadley
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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Saleh MA. A prospective study comparing patients with early and late relapsing pemphigus treated with rituximab. J Am Acad Dermatol 2018; 79:97-103. [PMID: 29408700 DOI: 10.1016/j.jaad.2018.01.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/15/2018] [Accepted: 01/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rituximab (RTX) is an effective therapy for patients with pemphigus; however, the therapy does not prevent relapse. OBJECTIVES To compare early relapsing patients (before 12 months) and late relapsing patients (after 24 months) following RTX therapy. METHOD In this prospective study, 19 patients were enrolled (14 with pemphigus vulgaris and 5 with pemphigus foliaceus). The baseline disease score, autoantibody levels, and percentage of CD20+ cells of patients with pemphigus were measured. Patients received 1 cycle of RTX and were followed for 26 months. RESULTS Among early relapsing patients (n = 5), the time to relapse was 6 to 11 months. Among late relapsing patients (n = 6), the time to relapse was 24 to 26 months. A significant difference was observed in the mean baseline anti-desmoglein 1 (DSG1) index between early relapsing (705.72) and late relapsing patients (210.4) (P = .0014). A significant negative correlation was found between the baseline anti-DSG1 index and time to relapse (r = -0.777, P = .00009). LIMITATIONS The small number of patients with pemphigus foliaceus. CONCLUSIONS Because patients with high baseline anti-DSG1 indices relapsed earlier, it may be important to follow these patients closely for the initial 12 months after RTX therapy. These patients may require a maintenance RTX dose during the first 12 months after RTX therapy.
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Tavakolpour S, Mahmoudi H, Balighi K, Abedini R, Daneshpazhooh M. Sixteen-year history of rituximab therapy for 1085 pemphigus vulgaris patients: A systematic review. Int Immunopharmacol 2018; 54:131-138. [DOI: 10.1016/j.intimp.2017.11.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/12/2017] [Accepted: 11/05/2017] [Indexed: 12/16/2022]
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Du FH, Mills EA, Mao-Draayer Y. Next-generation anti-CD20 monoclonal antibodies in autoimmune disease treatment. AUTOIMMUNITY HIGHLIGHTS 2017; 8:12. [PMID: 29143151 PMCID: PMC5688039 DOI: 10.1007/s13317-017-0100-y] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/03/2017] [Indexed: 01/02/2023]
Abstract
The clinical success of anti-CD20 monoclonal antibody (mAb)-mediated B cell depletion therapy has contributed to the understanding of B cells as major players in several autoimmune diseases. The first therapeutic anti-CD20 mAb, rituximab, is a murine-human chimera to which many patients develop antibodies and/or experience infusion-related reactions. A second generation of anti-CD20 mAbs has been designed to be more effective, better tolerated, and of lower immunogenicity. These include the humanized versions: ocrelizumab, obinutuzumab, and veltuzumab, and the fully human, ofatumumab. We conducted a literature search of relevant randomized clinical trials in the PubMed database and ongoing trials in Clinicaltrials.gov. Most of these trials have evaluated intravenous ocrelizumab or subcutaneous ofatumumab in rheumatoid arthritis, multiple sclerosis, or systemic lupus erythematosus. Understanding how newer anti-CD20 mAbs compare with rituximab in terms of efficacy, safety, convenience, and cost is important for guiding future management of anti-CD20 mAb therapy in autoimmune diseases.
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Affiliation(s)
| | - Elizabeth A Mills
- Molecular and Behavioral Neuroscience Institute, University of Michigan Medical School, Ann Arbor, USA
| | - Yang Mao-Draayer
- Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, USA. .,Department of Neurology, University of Michigan Medical School, 4015 A Alfred Taubman Biomedical Sciences Research Building, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA.
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Abstract
Pemphigus is a severe autoimmune blistering disease mediated by pathogenic anti-desmoglein antibodies leading to an inter keratinocyte disjunction. Rituximab is a monoclonal antibody that binds to the CD-20 antigen of B lymphocytes, which causes B-cell depletion and a subsequent reduction in pathogenic autoantibodies. Its therapeutic role in pemphigus has been progressively growing with increasing evidence of successful outcomes. Rituximab was initially off-labeled used as an alternative in patients with recalcitrant or relapsing pemphigus and in patients with contraindications to systemic corticosteroids. Recently, a large randomized clinical trial has shown that first-line use of rituximab combined with short-term prednisone regimen was both more effective and potentially safer than a standard regimen of high doses of corticosteroids in patients with moderate to severe pemphigus.
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Affiliation(s)
- Vivien Hebert
- Department of Dermatology, Rouen University Hospital, & INSERM U 1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, & INSERM U 1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
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