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Louchez A, El Aarbaoui T, Weill A, Gaudin O, Jelti L, Belmondo T, Wolkenstein P, Ingen-Housz-Oro S. Maintenance treatment of pemphigus with rituximab in real life: A single-center study of 50 patients. Ann Dermatol Venereol 2024; 151:103264. [PMID: 38537431 DOI: 10.1016/j.annder.2024.103264] [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: 04/25/2023] [Revised: 08/05/2023] [Accepted: 01/04/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Following the RITUX 3 therapeutic trial, the French national diagnosis and care protocol (NDCP) for the treatment of pemphigus was updated in 2018. The updated protocol recommends initial treatment with rituximab (RTX) followed by maintenance therapy at 12 and 18 months, and potentially at 6 months where there are risk factors for early relapse. We evaluated these recommendations regarding the management of our own patients. PATIENTS AND METHODS Our single-center retrospective study included all patients with pemphigus diagnosed between 01/2015 and 10/2020 and receiving at least one initial infusion of RTX. We collected the following data: type of pemphigus, severity, levels of anti-desmoglein 1 and 3 antibodies at diagnosis and between 2 and 6 months after initial RTX, presence or absence of maintenance therapy and modalities, time to first relapse and duration of associated systemic corticosteroid therapy ≥5 mg/day. Maintenance treatment modalities were as follows: no maintenance treatment, maintenance "on demand" (MT1) i.e. not performed at the rate imposed by the NDCP, and maintenance "according to NDCP" (MT2). RESULTS Fifty patients were included (women 54%, median age 58 years, pemphigus vulgaris 68%, moderate to severe 68%). Initial RTX was combined with systemic corticosteroid therapy at 0.5 to 1 mg/kg in 74% of cases. Twenty-seven patients (54%) received no maintenance therapy, 13 were on an MT1 regimen (26%), and 10 were on an MT2 regimen (20%). Median follow-up was 42 months. At the last follow-up, 39 patients (78%) were in complete remission. A total of 25 patients (50%) relapsed: 18/27 (67%) patients without maintenance, 5/13 (38%) with MT1, and 2/10 (20%) with MT2 (p = 0.026). The probability of relapse over time was significantly lower in patients receiving maintenance therapy compared to those who receiving none (p = 0.022). The median time to relapse was 15 months in patients without maintenance, and 30 and 28 in those with maintenance (p = 0.27). The median duration of systemic corticosteroid therapy ≥ 5 mg/day in the no-maintenance group was 10 months, compared to 7 and 9 months respectively in MT1 and MT2 (p = 0.91). CONCLUSION Our study confirms the value of RTX maintenance therapy in pemphigus in real life.
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Affiliation(s)
- A Louchez
- Dermatology Department, Henri-Mondor Hospital AP-HP, Créteil, France
| | - T El Aarbaoui
- Université Paris Est Créteil EpidermE, Créteil, France
| | - A Weill
- Dermatology Department, Henri-Mondor Hospital AP-HP, Créteil, France; Competence Center for Autoimmune Bullous Diseases MALIBUL, Henri-Mondor Hospital AP-HP, Créteil, France
| | - O Gaudin
- Dermatology Department, Henri-Mondor Hospital AP-HP, Créteil, France; Competence Center for Autoimmune Bullous Diseases MALIBUL, Henri-Mondor Hospital AP-HP, Créteil, France
| | - L Jelti
- Dermatology Department, Henri-Mondor Hospital AP-HP, Créteil, France; Competence Center for Autoimmune Bullous Diseases MALIBUL, Henri-Mondor Hospital AP-HP, Créteil, France
| | - T Belmondo
- Competence Center for Autoimmune Bullous Diseases MALIBUL, Henri-Mondor Hospital AP-HP, Créteil, France; Biological Immunology Department, Hôpital Henri-Mondor AP-HP, Créteil, France
| | - P Wolkenstein
- Dermatology Department, Henri-Mondor Hospital AP-HP, Créteil, France; Competence Center for Autoimmune Bullous Diseases MALIBUL, Henri-Mondor Hospital AP-HP, Créteil, France
| | - S Ingen-Housz-Oro
- Dermatology Department, Henri-Mondor Hospital AP-HP, Créteil, France; Université Paris Est Créteil EpidermE, Créteil, France; Competence Center for Autoimmune Bullous Diseases MALIBUL, Henri-Mondor Hospital AP-HP, Créteil, France.
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Hazard M, Bedane C, Ducharme O, Bernard P, Pham-Ledard AL. Evolution of rituximab use over time in moderate-to-severe pemphigus: A two-centre retrospective study. Ann Dermatol Venereol 2024; 151:103265. [PMID: 38552270 DOI: 10.1016/j.annder.2024.103265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/04/2023] [Accepted: 01/08/2024] [Indexed: 06/16/2024]
Affiliation(s)
- M Hazard
- Dermatology Department, Limoges University Hospital, Limoges, France.
| | - C Bedane
- Dermatology Department, Dijon University Hospital, Dijon, France
| | - O Ducharme
- Dermatology Department, Bordeaux University Hospital, Bordeaux, France
| | - P Bernard
- Dermatology Department, Limoges University Hospital, Limoges, France
| | - A-L Pham-Ledard
- Dermatology Department, Bordeaux University Hospital, Bordeaux, France
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Tedbirt B, Maho-Vaillant M, Houivet E, Mignard C, Golinski ML, Calbo S, Prost-Squarcioni C, Labeille B, Picard-Dahan C, Chaby G, Richard MA, Tancrede-Bohin E, Duvert-Lehembre S, Delaporte E, Bernard P, Caux F, Alexandre M, Musette P, 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. Sustained Remission Without Corticosteroids Among Patients With Pemphigus Who Had Rituximab as First-Line Therapy: Follow-Up of the Ritux 3 Trial. JAMA Dermatol 2024; 160:290-296. [PMID: 38265821 PMCID: PMC10809134 DOI: 10.1001/jamadermatol.2023.5679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
Importance The Ritux 3 trial demonstrated the short-term efficacy and safety of first-line treatment with rituximab compared with a standard corticosteroid regimen in pemphigus. No data on the long-term follow-up of patients who received rituximab as first line are available. Objective To assess the long-term efficacy and safety of the Ritux 3 treatment regimen. Design, Setting, and Participants This 7-year follow-up study of the Ritux 3 trial included patients with pemphigus from 25 dermatology departments in France from January 1, 2010, to December 31, 2015. Exposure Patients were initially randomized in the rituximab plus prednisone group or prednisone-alone group. Main outcomes and measures The primary outcome was the 5- and 7-year disease-free survival (DFS) without corticosteroids, assessed by Kaplan-Meier curves. Secondary outcomes were occurrence of relapse, occurrence of severe adverse events (SAEs), and evolution of antidesmoglein (Dsg) antibody enzyme-linked immunosorbent assay values to predict long-term relapse. Results Of the 90 patients in the Ritux 3 trial, 83 were evaluated at the end of follow-up study visit (44 in the rituximab plus prednisone group; 39 in the prednisone-alone group) with a median (IQR) follow-up of 87.3 (79.1-97.5) months. Forty-three patients (93%) from the rituximab plus prednisone and 17 patients (39%) from the prednisone-alone group had achieved complete remission without corticosteroids at any time during the follow-up. Patients from the rituximab group had much longer 5- and 7-year DFS without corticosteroids than patients from the prednisone-alone group (76.7% and 72.1% vs 35.3% and 35.3%, respectively; P < .001), and had about half the relapses (42.2% vs 83.7%; P < .001). Patients who received rituximab as second-line treatment had shorter DFS than patients treated as first line (P = .007). Fewer SAEs were reported in the rituximab plus prednisone group compared with the prednisone-alone group, 31 vs 58 respectively, corresponding to 0.67 and 1.32 SAEs per patient, respectively (P = .003). The combination of anti-Dsg1 values of 20 or more IU/mL and/or anti-Dsg3 values of 48 or more IU/mL yielded 0.83 positive predictive value and 0.94 negative predictive value to predict long-term relapse. Conclusions and Relevance In this secondary analysis of the Ritux 3 trail, first-line treatment of patients with pemphigus with the Ritux 3 regimen was associated with long-term sustained complete remission without corticosteroid therapy without any additional maintenance infusion of rituximab.
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Affiliation(s)
- Billal Tedbirt
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Maud Maho-Vaillant
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics and Clinical Research, CHU Rouen, Rouen, France
| | - Claire Mignard
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Marie-Laure Golinski
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Sébastien Calbo
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint-Étienne, Saint-Étienne, France
| | | | - Guillaume Chaby
- Department of Dermatology, University of Amiens, Amiens, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Centre in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Universitaire Hospital Timone, Assistance Publique Hôpitaux de Marseille, APHM, 13385, Marseille, France
| | | | | | | | | | - Frédéric Caux
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Marina Alexandre
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Philippe Musette
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Univ Paris Est Créteil EpiDermE, 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, APHP and University of Paris cité, 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, CHU Rouen and Inserm U1018, Université Paris-Saclay and Université de Rouen, Rouen, France
| | - Pascal Joly
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Vivien Hébert
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
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Xu C, Zhang T, Wang H, Zhu L, Ruan Y, Huang Z, Wang J, Zhu H, Huang C, Pan M. Integrative single-cell analysis reveals distinct adaptive immune signatures in the cutaneous lesions of pemphigus. J Autoimmun 2024; 142:103128. [PMID: 37939532 DOI: 10.1016/j.jaut.2023.103128] [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: 07/03/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
Pemphigus, an autoimmune bullous disease affecting the skin and mucosal membranes, is primarily driven by anti-desmoglein (Dsg) autoantibodies. However, the underlying immune mechanisms of this disease remain largely elusive. Here, we compile an unbiased atlas of immune cells in pemphigus cutaneous lesions at single-cell resolution. We reveal clonally expanded antibody-secreting cells (ASCs) that exhibit variable hypermutation and accumulation of IgG4 class-switching in their immunoglobulin genes. Importantly, pathogenic Dsg-specific ASCs are localized within pemphigus lesions and can evolve from both Dsg-autoreactive and non-binding precursors. We observe an altered distribution of CD4+ T cell subsets within pemphigus lesions, including an imbalance of Th17/Th2 cells. Significantly, we identify a distinct subpopulation of Th17 cells expressing CXCL13 and IL-21 within pemphigus lesions, implying its pivotal role in B cell recruitment and local production of autoantibodies. Furthermore, we characterize multiple clonally expanded CD8+ subpopulations, including effector GMZB+ and GMZK+ subsets with augmented cytotoxic activities, within pemphigus lesions. Chemokine-receptor mapping uncovers cell-type-specific signaling programs involved in the recruitment of T/B cells within pemphigus lesions. Our findings significantly contribute to advancing the understanding of the heterogeneous immune microenvironment and the pathogenesis of pemphigus cutaneous lesions, thereby providing valuable insights for potential therapeutic interventions in this disease.
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Affiliation(s)
- Chuqiao Xu
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyu Zhang
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Biliary Tract Disease Research, Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Faculty of Basic Medicine, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hailun Wang
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Zhu
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Ruan
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zixuan Huang
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingying Wang
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiqin Zhu
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanxin Huang
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Biliary Tract Disease Research, Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Faculty of Basic Medicine, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Meng Pan
- Department of Dermatology, Center for Immune-Related Diseases at Shanghai Institute of Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Didona D, Schmidt MF, Maglie R, Solimani F. Pemphigus and pemphigoids: Clinical presentation, diagnosis and therapy. J Dtsch Dermatol Ges 2023; 21:1188-1209. [PMID: 37587612 DOI: 10.1111/ddg.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/11/2023] [Indexed: 08/18/2023]
Abstract
Pemphigus and pemphigoid are two potentially life-threatening groups of autoimmune diseases, characterized by autoantibodies targeting structural components of desmosomes or hemidesmosomes, respectively. Affected patients typically show itchy/painful plaques or blistering skin lesions and/or impairing mucosal blistering and erosions, which may strongly impact their quality of life. Since the milestone work of Walter Lever in 1953, who differentiated these two groups of diseases by histopathological analysis of the level of antibody-mediated skin cleavage, enormous progresses occurred. Achievements made in laboratory diagnostics now allow to identify antigen specific structural proteins of the skin that are targeted by pathogenic autoantibodies. These progresses were accompanied by an increased understanding of the pathogenesis of these diseases thanks to the establishment of animal models reproducing disease and on studies on skin and blood of affected individuals, which have been leading to novel and disease-specific treatments. Yet, given their phenotypical overlap with more common dermatological diseases, correct diagnosis and appropriate treatment are often delayed, in some cases leading to irreversible sequelae, including organ dysfunction (i.e., loss of vision in mucous membrane pemphigoid). Here, we provide a concise overview of the clinical appearance, diagnosis and therapeutic management of pemphigus and pemphigoid diseases.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Morna F Schmidt
- Department of Dermatology and Allergology, University Hospital RWTH Aachen, Aachen, Germany
| | - Roberto Maglie
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Germany
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Didona D, Schmidt MF, Maglie R, Solimani F. Pemphigus- und Pemphigoid-Erkrankungen: Klinik, Diagnostik und Therapie: Pemphigus and pemphigoids: Clinical presentation, diagnosis and therapy. J Dtsch Dermatol Ges 2023; 21:1188-1211. [PMID: 37845066 DOI: 10.1111/ddg.15174_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/11/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungPemphigus und Pemphigoid sind seltene Autoimmunkrankheiten der Haut mit potenziell lebensbedrohlichem Verlauf. Autoantikörper gegen epidermale und junktionale Strukturproteine (Desmosomen sowie Hemidesmosomen) führen bei Betroffenen typischerweise zu juckenden, schmerzhaften Plaques oder Blasen an der Haut und/oder Blasenbildung und Erosionen der Schleimhäute mit möglicher Einschränkung der Lebensqualität. Seit der bahnbrechenden Arbeit von Walter Lever im Jahr 1953, dem es gelang, mittels histopathologischer Untersuchung diese beiden Krankheitsgruppen anhand des Musters der Antikörper‐vermittelten Blasenbildung zu differenzieren, wurden enorme Fortschritte im Verständnis der Erkrankungen erzielt. Die Errungenschaften in der Labordiagnostik ermöglichten die Identifikation von Zielstrukturen zur präzisen Unterscheidung verschiedener Varianten der bullösen Autoimmunerkrankungen. Diese Fortschritte gingen dank der Entwicklung von Tiermodellen mit einem besseren Verständnis der Pathogenese einher. Außerdem haben Studien an Haut und Blut betroffener Patienten zu neuen und krankheitsspezifischen Behandlungen geführt. Aufgrund ihrer Seltenheit und der klinischen Ähnlichkeit mit anderen dermatologischen Erkrankungen verzögern sich die korrekte Diagnosestellung und die Einleitung einer entsprechenden Therapie häufig, was in einigen Fällen zu irreversiblen Folgeerscheinungen, einschließlich Funktionsstörungen von Organen (zum Beispiel Verlust des Sehvermögens beim Schleimhautpemphigoid) führt. Wir geben hier einen Überblick über das klinische Erscheinungsbild, den Diagnosealgorithmus und das therapeutische Management von Pemphigus‐ und Pemphigoid‐Erkrankungen.
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Affiliation(s)
- Dario Didona
- Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Morna F Schmidt
- Klinik für Dermatologie und Allergologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Roberto Maglie
- Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Marburg, Deutschland
- Abteilung für Gesundheitswissenschaften, Abteilung für Dermatologie, Universität Florenz, Florenz, Italien
| | - Farzan Solimani
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Korporatives Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Deutschland
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Deutschland
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Abulikemu K, Hu F, Liang J, Kang X. Targeting therapy in pemphigus: Where are we now and where are we going? Heliyon 2023; 9:e16679. [PMID: 37292301 PMCID: PMC10245244 DOI: 10.1016/j.heliyon.2023.e16679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Pemphigus is a heterogeneous group of autoimmune skin disorders characterized by blistering of the skin and mucosal membranes, potentially affecting the quality of life if left unchecked. The current mainstay of treatment is systemic corticosteroids and immunosuppressive agents. Nevertheless, long-term use of these drugs can easily cause infections and other life-threatening adverse reactions. Thus, currently, researchers are trying to develop new and safer therapeutic approaches. Specifically, targeted therapies to pathogenic immune pathways have been gradually introduced and used for the treatment of pemphigus or in clinical trials, such as monoclonal anti-CD20 antibody, BAFF inhibitor, BTK inhibitor, CAAR-T therapy, FcRn antagonist, and TNF-α inhibitor. In addition, IL-4Rα antibody, IL-17 blockade, mTOR pathway inhibitor, CTLA-4Ig, and p38 MAPK inhibitors are theoretically promising treatment for pemphigus. Here, we review the research progress on the mechanism of targeted therapies for pemphigus.
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Kianfar N, Dasdar S, Daneshpazhooh M, Aryanian Z, Goodarzi A. A systematic review on efficacy, safety and treatment durability of intravenous immunoglobulin in autoimmune bullous dermatoses: Special focus on indication and combination therapy. Exp Dermatol 2023. [PMID: 37150538 DOI: 10.1111/exd.14829] [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: 01/26/2023] [Revised: 04/10/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023]
Abstract
Autoimmune bullous diseases (AIBDs) are a group of rare blistering dermatoses of the mucous membrane and/or skin. The efficacy, safety and treatment durability of intravenous immunoglobulin (IVIg) as an alternative treatment should be explored to systematically review the available literature regarding treatment outcomes with IVIg in AIBD patients. The predefined search strategy was incorporated into the following database, MEDLINE/PubMed, Embase, Scopus and Web of Science on 18 July 2022. Sixty studies were enrolled using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The use of IVIg alone or combined with rituximab was reported in 500 patients with pemphigus, 82 patients with bullous pemphigoid, 146 patients with mucous membranes pemphigoid and 19 patients with epidermolysis bullosa acquisita. Disease remission with IVIg therapy and RTX + IVIg combination therapy were recorded as 82.8% and 86.7% in pemphigus, 88.0% and 100% in bullous pemphigoid and 91.3% and 75.0% in mucous membrane pemphigoid, respectively. In epidermolysis bullosa acquisita, treatment with IVIg led to 78.6% disease remission; no data were available regarding the treatment with RTX + IVIg in this group of patients. Among all the included patients, 37.5% experienced at least one IVIg-related side effect; the most common ones were headaches, fever/chills and nausea/vomiting. The use of IVIg with or without rituximab had a favourable clinical response in patients with AIBDs. IVIg has no major influence on the normal immune system, which makes its utilization for patients with AIBDs reasonable.
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Affiliation(s)
- Nika Kianfar
- Department of Dermatology, Razi Dermatology Hospital, Autoimmune Bullous Diseases Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Dasdar
- Department of Dermatology, Razi Dermatology Hospital, Autoimmune Bullous Diseases Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Razi Dermatology Hospital, Autoimmune Bullous Diseases Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Aryanian
- Department of Dermatology, Razi Dermatology Hospital, Autoimmune Bullous Diseases Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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BOCH K, LANGAN EA, VAN BEEK N, KRIDIN K, SCHMIDT E, ZILLIKENS D, LUDWIG RJ, HAMMERS CM, BIEBER K. Faster IgG4 Depletion Kinetics Observed for Anti-Desmoglein 3 Autoantibodies Following Rituximab Treatment in Patients with Pemphigus Vulgaris. Acta Derm Venereol 2022; 102:adv00835. [PMID: 36511332 PMCID: PMC9811284 DOI: 10.2340/actadv.v102.4490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Katharina BOCH
- Department of Dermatology, University of Luebeck, Ratzeburger Allee 160, DE-23562 Luebeck, Germany
| | - Ewan A. LANGAN
- Department of Dermatology, University of Luebeck, Ratzeburger Allee 160, DE-23562 Luebeck, Germany,Manchester Sciences, University of Manchester, Manchester, UK
| | - Nina VAN BEEK
- Department of Dermatology, University of Luebeck, Ratzeburger Allee 160, DE-23562 Luebeck, Germany,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Khalaf KRIDIN
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Enno SCHMIDT
- Department of Dermatology, University of Luebeck, Ratzeburger Allee 160, DE-23562 Luebeck, Germany,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef ZILLIKENS
- Department of Dermatology, University of Luebeck, Ratzeburger Allee 160, DE-23562 Luebeck, Germany
| | - Ralf J. LUDWIG
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Christoph M. HAMMERS
- Department of Dermatology, University of Luebeck, Ratzeburger Allee 160, DE-23562 Luebeck, Germany,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany,Department of Dermatology, Christian-Albrechts-University, Kiel, Germany
| | - Katja BIEBER
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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Font G, Walet-Balieu ML, Petit M, Burel C, Maho-Vaillant M, Hébert V, Chan P, Fréret M, Boyer O, Joly P, Calbo S, Bardor M, Golinski ML. IgG N-Glycosylation from Patients with Pemphigus Treated with Rituximab. Biomedicines 2022; 10:biomedicines10081774. [PMID: 35892674 PMCID: PMC9330150 DOI: 10.3390/biomedicines10081774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
Pemphigus is a life-threatening auto-immune blistering disease of the skin and mucous membrane that is caused by the production of auto-antibodies (auto-Abs) directed against adhesion proteins: desmoglein 1 and 3. We demonstrated in the “Ritux3” trial, the high efficacy of rituximab, an anti-CD20 recombinant monoclonal antibody, as the first-line treatment for pemphigus. However, 25% of patients relapsed during the six-month period after rituximab treatment. These early relapses were associated with a lower decrease in anti-desmoglein auto-Abs after the initial cycle of rituximab. The N-glycosylation of immunoglobulin-G (IgG) can affect their affinity for Fc receptors and their serum half-life. We hypothesized that the extended half-life of Abs could be related to modifications of IgG N-glycans. The IgG N-glycome from pemphigus patients and its evolution under rituximab treatment were analyzed. Pemphigus patients presented a different IgG N-glycome than healthy donors, with less galactosylated, sialylated N-glycans, as well as a lower level of N-glycans bearing an additional N-acetylglucosamine. IgG N-glycome from patients who achieved clinical remission was not different to the one observed at baseline. Moreover, our study did not identify the N-glycans profile as discriminating between relapsing and non-relapsing patients. We report that pemphigus patients present a specific IgG N-glycome. The changes observed in these patients could be a biomarker of autoimmunity susceptibility rather than a sign of inflammation.
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Affiliation(s)
- Guillaume Font
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
| | - Marie-Laure Walet-Balieu
- Université de Rouen Normandie, Laboratoire Glyco-MEV UR 4358, SFR Normandie Végétal FED 4277, Innovation Chimie Carnot, F-76000 Rouen, France; (M.-L.W.-B.); (C.B.); (M.B.)
| | - Marie Petit
- Université de Rouen Normandie, Inserm U1234, F-76000 Rouen, France; (M.P.); (S.C.)
| | - Carole Burel
- Université de Rouen Normandie, Laboratoire Glyco-MEV UR 4358, SFR Normandie Végétal FED 4277, Innovation Chimie Carnot, F-76000 Rouen, France; (M.-L.W.-B.); (C.B.); (M.B.)
| | - Maud Maho-Vaillant
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
| | - Vivien Hébert
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
| | - Philippe Chan
- Université de Rouen Normandie, INSERM US 51, CNRS UAR 2026, HeRacLeS-PISSARO, Normandie Université, F-76000 Rouen, France;
| | - Manuel Fréret
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Rhumatology, F-76000 Rouen, France;
| | - Olivier Boyer
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Immunology and Biotherapy, F-76000 Rouen, France;
| | - Pascal Joly
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
| | - Sébastien Calbo
- Université de Rouen Normandie, Inserm U1234, F-76000 Rouen, France; (M.P.); (S.C.)
| | - Muriel Bardor
- Université de Rouen Normandie, Laboratoire Glyco-MEV UR 4358, SFR Normandie Végétal FED 4277, Innovation Chimie Carnot, F-76000 Rouen, France; (M.-L.W.-B.); (C.B.); (M.B.)
- Université de Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, F-59000 Lille, France
| | - Marie-Laure Golinski
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
- Correspondence: ; Tel.: +33-2-35-14-83-49
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Lemieux A, Maho-Vaillant M, Golinski ML, Hébert V, Boyer O, Calbo S, Candon S, Joly P. Evaluation of Clinical Relevance and Biological Effects of Antirituximab Antibodies in Patients With Pemphigus. JAMA Dermatol 2022; 158:893-899. [PMID: 35731529 DOI: 10.1001/jamadermatol.2022.2149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The clinical relevance of antirituximab antibodies (ARAs) in patients with pemphigus who are treated with rituximab (RTX) is currently unknown. Objective To determine the prevalence of ARAs in patients with pemphigus who are treated with RTX and their association with complete remission (CR) and relapse. Design, Setting, and Participants This post hoc analysis of the Ritux3 trial was conducted from January 2010 to December 2015 in 25 dermatology departments in France and included 42 patients with moderate-to-severe pemphigus who were randomized to receive treatment with RTX. Five additional patients were recruited for an ancillary study. The proportions of patients who achieved CR or relapsed after an initial treatment cycle of RTX were compared depending on whether patients had ARAs. Exposures Patients were treated with 1000 mg of RTX on days 1 and 15 and 2 maintenance infusions of 500 mg at months 12 and 18. Main Outcomes and Measures Rates of relapse and sustained CR at month 36. Levels of ARAs, antidesmoglein 1/3 antibodies, RTX serum concentrations, and peripheral blood CD19+ B-cell frequency were measured. Results Of 42 participants with vs without ARAs, the mean (SD) age was 55 (17) years and 56 (17) years, respectively; 25 (59.5%) were women. Antirituximab antibodies were detected in the serum samples of 13 of 42 patients (31%) during the first year. Nine patients who experienced relapse before month 12 were excluded because they received additional infusions and could not be further analyzed. Among the 33 remaining patients, 2 patients (6.1%) experienced relapse after month 12, and 31 (95.9%) maintained a sustained CR until month 36. The rate of sustained CR was not different whether patients had ARAs (11 of 13 [85%]) or not (20 of 20 [100%]) (P = .15). Both groups (ARA+ vs ARA-) also had similar CD19+ B-cell depletion and RTX levels, but patients with ARAs had higher anti-desmoglein 3 antibody (DSG3 Abs) levels compared with those without ARAs (mean [SD], 30.1 [50.9] AU/mL vs 4.0 [4.3] AU/mL; P = .03). The 2 patients with ARAs who experienced relapse after month 12 had an undetectable RTX level, incomplete B-cell depletion, and higher anti-DSG3 Abs level than the 11 patients who maintained a sustained CR with ARAs (RTX mean [SD] concentration, 0 ug/mL vs 12.5 [2.2] ug/mL; P = .03; incomplete B-cell depletion, 2 of 2 vs 4 of 11; P = .19; mean [SD] anti-DSG3 Abs levels, 103.5 [61.5] AU/mL vs 19.5 [11.0] AU/mL; P = .001) or patients without ARAs (mean [SD] RTX concentration, 0 ug/mL vs 13.5 [1.8] ug/mL; P = .02; incomplete B-cell depletion, 2 of 2 vs 5 of 20; P = .09; mean [SD] anti-DSG3 Abs level, 103.5 [61.5] AU/mL vs 4.0 [1.0] AU/mL; P < .001). Conclusions and Relevance The results of this cohort study suggest that ARAs are frequently detected in patients with pemphigus who are treated with RTX and generally are not associated with patient outcomes. Only a few patients with the combination of ARAs, low RTX concentration, incomplete B-cell depletion, and persistent serum anti-DSG3 Abs seem at high risk of relapse.
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Affiliation(s)
- Alexandre Lemieux
- Department of Dermatology, Normandie University, Université de Rouen, Inserm U1234, CHU Rouen, Rouen, France
| | - Maud Maho-Vaillant
- Department of Dermatology, Normandie University, Université de Rouen, Inserm U1234, CHU Rouen, Rouen, France
| | - Marie-Laure Golinski
- Department of Dermatology, Normandie University, Université de Rouen, Inserm U1234, CHU Rouen, Rouen, France
| | - Vivien Hébert
- Department of Dermatology, Normandie University, Université de Rouen, Inserm U1234, CHU Rouen, Rouen, France
| | - Olivier Boyer
- Department of Immunology, Normandie University, Université de Rouen, Inserm U1234, CHU Rouen, Rouen, France.,Normandie University, Université de Rouen, Inserm U1234, Rouen, France
| | - Sébastien Calbo
- Normandie University, Université de Rouen, Inserm U1234, Rouen, France
| | - Sophie Candon
- Department of Immunology, Normandie University, Université de Rouen, Inserm U1234, CHU Rouen, Rouen, France.,Normandie University, Université de Rouen, Inserm U1234, Rouen, France
| | - Pascal Joly
- Department of Dermatology, Normandie University, Université de Rouen, Inserm U1234, CHU Rouen, Rouen, France
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12
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Martora F, Picone V, Fabbrocini G, Megna M. How to decrease systemic corticosteroids in pemphigus patients under rituximab. Health Sci Rep 2022; 5:e639. [PMID: 35677471 PMCID: PMC9169508 DOI: 10.1002/hsr2.639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Fabrizio Martora
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Vincenzo Picone
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Matteo Megna
- Dermatology Unit, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
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Maho-Vaillant M, Sips M, Golinski ML, Vidarsson G, Goebeler M, Stoevesandt J, Bata-Csörgő Z, Balbino B, Verheesen P, Joly P, Hertl M, Calbo S. FcRn Antagonism Leads to a Decrease of Desmoglein-Specific B Cells: Secondary Analysis of a Phase 2 Study of Efgartigimod in Pemphigus Vulgaris and Pemphigus Foliaceus. Front Immunol 2022; 13:863095. [PMID: 35663943 PMCID: PMC9157593 DOI: 10.3389/fimmu.2022.863095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
Background Immunoglobulin G (IgG) levels are maintained by the IgG-recycling neonatal Fc-receptor (FcRn). Pemphigus vulgaris and pemphigus foliaceus are debilitating autoimmune disorders triggered by IgG autoantibodies against mucosal and epidermal desmogleins. Recently, a phase 2 clinical trial (NCT03334058; https://clinicaltrials.gov/NCT03334058) was completed in participants with pemphigus using efgartigimod, an FcRn inhibitor, in combination with prednisone. Efgartigimod demonstrated an early effect on diease activity and was well tolerated. In addition to the safety and efficacy assessment, clinical trials present an opportunity to gain more insights into the mechanism of disease, the mode of action of treatment, and potential for corticosteroid-sparing activity. Objective The aim of our study was to assess the impact of FcRn antagonism by efgartigimod on immunological parameters known to be directly involved in pemphigus pathology, such as cellular and serological responses. Methods We investigated total and antigen-specific IgG subclass level kinetics during and after treatment, assessed antigen-specific B-cell responses, followed T- and B-cell immunophenotypes, and analyzed how different immunophenotypes link to clinical response. Results Treatment resulted in reduction of total IgG as well as autoreactive IgG antibody levels. Surprisingly, unlike total IgG and vaccine- or natural-infection-elicited IgG, which returned to baseline levels after stopping efgartigimod treatment, autoreactive antibody levels remained low in several study participants. Efgartigimod showed no effect on total leukocytes, neutrophils, monocytes, or lymphocytes in patients treated with extended efgartigimod therapy. Intriguingly, antigen-specific analyses revealed a loss of desmoglein-specific B cells in several participants responding to efgartigimod, in line with prolonged reduction of pathogenic IgG levels. Conclusions Efgartigimod treatment of participants with pemphigus improved their conditions and exerted an immunomodulatory effect beyond the blockade of IgG recycling. Further studies in larger populations with an appropriate placebo control are needed to confirm these potentially important observations to establish long-term clinical responses in autoimmune diseases.
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Affiliation(s)
- Maud Maho-Vaillant
- Department of Dermatology, Rouen University Hospital, Rouen, France
- INSERM U1234, Normandie University, Rouen, France
| | | | - Marie-Laure Golinski
- Department of Dermatology, Rouen University Hospital, Rouen, France
- INSERM U1234, Normandie University, Rouen, France
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | | | | | | | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
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14
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Nili A, Karimi S, Salehi Farid A, Molhem Azar P, Farimani Z, Shahbazian H, Balighi K, Tavakolpour S, Mahmoudi H, Daneshpazhooh M. Factors associated with the healing time of pemphigus vulgaris oral lesions: a prospective study. Oral Dis 2022. [PMID: 35506253 DOI: 10.1111/odi.14236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study determines the healing time of lesions on different locations and the contributing factors to the healing time in patients with pemphigus. METHODS In this prospective study, newly diagnosed patients with mucosal lesions were included. A dermatologist evaluated the lesions, disease status, side effects and assigned the PDAI. Follow-up visits were conducted monthly until the patient reached complete remission and every three months thereafter. A Tzanck smear was performed on lesions clinically suspected to be herpetic in origin. RESULTS Sixty patients enrolled in the study with a mean age of 45.9 ± 11.7 years. The buccal lesions took the longest to resolve(73[33.5-105.5] days). However, the posterior pharynx lesions showed the shortest healing time(20[13.0-25.5] days). The likelihood of improvement in buccal and soft palate lesions decreased by 5% and 3% with each additional year of age, respectively. Also, the resolution duration of soft palate lesions was significantly shorter in female patients than males(median of 24.0 days vs. 38.5 days). In contrast, lower gingival lesions resolve significantly faster in male patients by a median of 9 days. HSV infection increases the healing time of lesions by 26 days(median of 55 days vs. 29 days, hazard ratio 2.62, 95%CI:1.04-5.92). CONCLUSIONS Buccal and lower gingival lesions are more recalcitrant to treatment, while posterior pharynx lesions heal most rapidly. Furthermore, older age was also associated with a lower rate of lesion improvement.
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Affiliation(s)
- Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shakiba Karimi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Molhem Azar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Farimani
- Department of Periodontics, School of Dentistry, Alborz University of Medical Science, Karaj, Iran
| | | | - Kamran Balighi
- 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
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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15
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Golinski ML, Lemieux A, Maho-Vaillant M, Barray M, Drouot L, Schapman D, Petit M, Hertl M, Boyer O, Calbo S, Joly P, Hébert V. The Diversity of Serum Anti-DSG3 IgG Subclasses Has a Major Impact on Pemphigus Activity and Is Predictive of Relapses After Treatment With Rituximab. Front Immunol 2022; 13:849790. [PMID: 35371083 PMCID: PMC8965561 DOI: 10.3389/fimmu.2022.849790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction We studied the distribution and in vitro pathogenicity of anti-DSG3 IgG subclasses during the course of pemphigus vulgaris (PV). Methods We longitudinally studied the distribution of anti-DSG3 IgG subclasses (before versus after treatment) in sera from PV patients, using an addressable-laser bead immunoassay (ALBIA). The in vitro pathogenicity of corresponding sera was tested using keratinocyte dissociation and immunofluorescence assays. Results Sixty-five sera were assessed at baseline (33 from patients treated with rituximab and 32 with corticosteroids). Sixty-three percent of these baseline sera contained 2 or more anti-DSG3 IgG subclasses versus 35.7% of sera from patients in complete remission (CR) and 75.0% of sera from patients with persistent disease activity after treatment. IgG4 was the most frequently detected anti-DSG3 IgG subclass, both in patients with disease activity and in those in CR. The presence of three or more anti-DSG3 IgG subclasses was predictive of relapse, in particular when it included IgG3, with a positive predictive value of 62.5% and a negative predictive value of 92%. While anti-DSG3 IgG4 Abs from sera collected before treatment were most often pathogenic, anti-DSG3 IgG4 from sera collected after treatment were pathogenic only after adjusting their titer to the one measured before treatment. The IgG3 fraction containing anti-DSG3 Abs also had an in vitro pathogenic effect. The disappearance of the pathogenic effect of some sera after removal of anti-DSG3 IgG3 suggested an additional effect of this IgG subclass. Conclusion The serum levels and number of anti-DSG3 IgG subclasses drive the pathogenic effect of pemphigus sera and may predict the occurrence of relapses.
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Affiliation(s)
- Marie-Laure Golinski
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
| | - Alexandre Lemieux
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
| | - Maud Maho-Vaillant
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
| | - Marion Barray
- Normandie Univ, UNIROUEN, Inserm U1234, Rouen, France
| | | | | | - Marie Petit
- Normandie Univ, UNIROUEN, Inserm U1234, Rouen, France
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Olivier Boyer
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Immunology, Rouen, France
| | | | - Pascal Joly
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
| | - Vivien Hébert
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
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16
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Marniquet ME, Joly P, Dansette D, Fenot M. A Case of Pemphigus Herpetiformis Successfully Treated with Rituximab. J Eur Acad Dermatol Venereol 2022; 36:e686-e688. [PMID: 35363902 DOI: 10.1111/jdv.18122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/03/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- M-E Marniquet
- Department of dermatology, CHD Vendée, La Roche Sur Yon, France
| | - P Joly
- Department of dermatology, CHU de Rouen, France
| | - D Dansette
- Department of Anatomopathology, CHD Vendée, La Roche Sur Yon, France
| | - M Fenot
- Department of dermatology, CHD Vendée, La Roche Sur Yon, France
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17
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Koneczny I, Tzartos J, Mané-Damas M, Yilmaz V, Huijbers MG, Lazaridis K, Höftberger R, Tüzün E, Martinez-Martinez P, Tzartos S, Leypoldt F. IgG4 Autoantibodies in Organ-Specific Autoimmunopathies: Reviewing Class Switching, Antibody-Producing Cells, and Specific Immunotherapies. Front Immunol 2022; 13:834342. [PMID: 35401530 PMCID: PMC8986991 DOI: 10.3389/fimmu.2022.834342] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
Organ-specific autoimmunity is often characterized by autoantibodies targeting proteins expressed in the affected tissue. A subgroup of autoimmunopathies has recently emerged that is characterized by predominant autoantibodies of the IgG4 subclass (IgG4-autoimmune diseases; IgG4-AID). This group includes pemphigus vulgaris, thrombotic thrombocytopenic purpura, subtypes of autoimmune encephalitis, inflammatory neuropathies, myasthenia gravis and membranous nephropathy. Although the associated autoantibodies target specific antigens in different organs and thus cause diverse syndromes and diseases, they share surprising similarities in genetic predisposition, disease mechanisms, clinical course and response to therapies. IgG4-AID appear to be distinct from another group of rare immune diseases associated with IgG4, which are the IgG4-related diseases (IgG4-RLD), such as IgG4-related which have distinct clinical and serological properties and are not characterized by antigen-specific IgG4. Importantly, IgG4-AID differ significantly from diseases associated with IgG1 autoantibodies targeting the same organ. This may be due to the unique functional characteristics of IgG4 autoantibodies (e.g. anti-inflammatory and functionally monovalent) that affect how the antibodies cause disease, and the differential response to immunotherapies of the IgG4 producing B cells/plasmablasts. These clinical and pathophysiological clues give important insight in the immunopathogenesis of IgG4-AID. Understanding IgG4 immunobiology is a key step towards the development of novel, IgG4 specific treatments. In this review we therefore summarize current knowledge on IgG4 regulation, the relevance of class switching in the context of health and disease, describe the cellular mechanisms involved in IgG4 production and provide an overview of treatment responses in IgG4-AID.
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Affiliation(s)
- Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- *Correspondence: Inga Koneczny,
| | - John Tzartos
- Neuroimmunology, Tzartos NeuroDiagnostics, Athens, Greece
- 2nd Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Mané-Damas
- Research Group Neuroinflammation and Autoimmunity, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Maartje G. Huijbers
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Konstantinos Lazaridis
- Department of Immunology, Laboratory of Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Pilar Martinez-Martinez
- Research Group Neuroinflammation and Autoimmunity, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Socrates Tzartos
- Neuroimmunology, Tzartos NeuroDiagnostics, Athens, Greece
- Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry and Department of Neurology, UKSH Kiel/Lübeck, Kiel University, Kiel, Germany
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Nosrati A, Mimouni T, Hodak E, Gdalevich M, Oren-Shabtai M, Levi A, Mimouni D, Leshem YA. Early rituximab treatment is associated with increased and sustained remission in pemphigus patients: a retrospective cohort of 99 patients. Dermatol Ther 2022; 35:e15397. [PMID: 35194896 DOI: 10.1111/dth.15397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/25/2021] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Rituximab is the front-line therapy for pemphigus disease. Although very effective, relapse rates are high. We assessed factors associated with disease remission and early relapse following the first rituximab cycle. MATERIAL AND METHODS A single center, retrospective cohort study of patients with pemphigus treated with rituximab (1000 mg days 0,14) at the Autoimmune Bullous Disease Clinic of the Division of Dermatology in Rabin Medical Center, Israel, between January 1, 1995 and March 31, 2020. RESULTS The cohort included 99 patients with a median follow-up of 37 months (range 12-155). After a single rituximab cycle, 74 patients (75%) achieved remission. Increased time to rituximab was associated with decreased remission rates (OR, 0.98 per month; 95%CI, 0.97-0.998). Of patients in remission with sufficient follow-up, 15/69 (22%) experienced an early relapse (≤12 months from remission). Prolonged time to rituximab and increased baseline disease severity, were associated with early relapse (OR, 1.02 per month; 95%CI, 1.001-1.04; OR, 1.04 per point; 95%CI, 1.01-1.08, accordingly). CONCLUSIONS Initiating rituximab early following diagnosis is recommended. Maintenance rituximab infusions, especially for patients with severe baseline disease, should be further investigated.
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Affiliation(s)
- Adi Nosrati
- Division of Dermatology, Rabin Medical Center, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Mimouni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Gdalevich
- Israel Ministry of Health, Southern District, Beer Sheva, Israel.,Faculty of Health Sciences, Department of Health Systems Management, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Meital Oren-Shabtai
- Division of Dermatology, Rabin Medical Center, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assi Levi
- Division of Dermatology, Rabin Medical Center, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Mimouni
- Division of Dermatology, Rabin Medical Center, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael A Leshem
- Division of Dermatology, Rabin Medical Center, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Lim YL, Bohelay G, Hanakawa S, Musette P, Janela B. Autoimmune Pemphigus: Latest Advances and Emerging Therapies. Front Mol Biosci 2022; 8:808536. [PMID: 35187073 PMCID: PMC8855930 DOI: 10.3389/fmolb.2021.808536] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022] Open
Abstract
Pemphigus represents a group of rare and severe autoimmune intra-epidermal blistering diseases affecting the skin and mucous membranes. These painful and debilitating diseases are driven by the production of autoantibodies that are mainly directed against the desmosomal adhesion proteins, desmoglein 3 (Dsg3) and desmoglein 1 (Dsg1). The search to define underlying triggers for anti-Dsg-antibody production has revealed genetic, environmental, and possible vaccine-driven factors, but our knowledge of the processes underlying disease initiation and pathology remains incomplete. Recent studies point to an important role of T cells in supporting auto-antibody production; yet the involvement of the myeloid compartment remains unexplored. Clinical management of pemphigus is beginning to move away from broad-spectrum immunosuppression and towards B-cell-targeted therapies, which reduce many patients’ symptoms but can have significant side effects. Here, we review the latest developments in our understanding of the predisposing factors/conditions of pemphigus, the underlying pathogenic mechanisms, and new and emerging therapies to treat these devastating diseases.
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Affiliation(s)
- Yen Loo Lim
- Department of Dermatology, National Skin Centre, Singapore
| | - Gerome Bohelay
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Sho Hanakawa
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Philippe Musette
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Baptiste Janela
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore
- Singapore Immunology network, Agency for Science, Technology and Research (A*STAR), Singapore
- *Correspondence: Baptiste Janela,
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20
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Balighi K, Ashtar Nakhaei N, Daneshpazhooh M, Aryanian Z, Aslani S, Balighi S, Azizpour A. Pemphigus patients with initial negative levels of anti- desmoglein; a subtype with different profile? Dermatol Ther 2022; 35:e15299. [PMID: 34981632 DOI: 10.1111/dth.15299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/04/2021] [Accepted: 12/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pemphigus is a blistering autoimmune disease that is characterized by autoantibodies against desmoglins (Dsg), including anti-Dsg1 and anti-Dsg3. Despite the diagnosis of diseases, the anti-Dsg test by Enzyme-linked immunosorbent assay (ELISA) is negative in a small group of pemphigus patients. The aim of this study was to evaluate the clinical course, clinical symptoms, and response to treatment in pemphigus patients with negative levels of anti-Dsg1 and anti-Dsg3. METHODS In this study, the data of pemphigus patients referred to Razi Hospital were retrospectively collected from the medical records from 2016 to 2020. Eight patients, whose initial anti-Dsg1/anti-Dsg3 was negative by the ELISA test, were enrolled and their clinical course, clinical signs, and response to treatment were evaluated. RESULTS The mean age of the subjects (8 females) was 38.75±12.09. The most common phenotype of the subjects was pemphigus vulgaris (PV) with mucosal involvement. Additionally, the common site of blister inception was mouth of the patients. The mean prednisolone dose received by the patients at the initiation was 32.5±13.62 mg/day. According to Pemphigus Disease Area Index (PDAI), 6 patients had mild severity, wile 2 cases had moderate severity. Among the patients, 6 subjects received rituximab (RTX). Also, 5 patients experienced remission after 6.2±5.21 months. CONCLUSION PV is the most common phenotype of the disease and mucosal involvement is more common in patients with negative anti-Dsg-1/3 results. The severity of the lesions in most of the patients is mild at baseline and most patients seems to respond to RTX therapy and reach remission.
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Affiliation(s)
- Kamran Balighi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ashtar Nakhaei
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Aryanian
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
| | - Saeed Aslani
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Balighi
- The school of allied medical sciences, Tehran University of Medical Sciences
| | - Arghavan Azizpour
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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21
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Tovanabutra N, Bax CE, Feng R, Kushner CJ, Payne AS. Temporal outcomes after rituximab therapy for pemphigus vulgaris. J Invest Dermatol 2021; 142:1058-1064.e7. [PMID: 34710389 DOI: 10.1016/j.jid.2021.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
Pemphigus vulgaris is an autoimmune blistering disease characterized by autoantibodies that target desmoglein adhesion proteins. Rituximab and corticosteroids are FDA-approved therapies for pemphigus vulgaris. As newer treatments for pemphigus enter clinical trials, analysis of clinical and serologic outcomes after rituximab therapy as a function of time is essential to guide clinical trial design. Here, we report detailed temporal and serological outcomes of rituximab treatment of pemphigus vulgaris. The maximal prevalence of complete remission off oral systemic therapy after a single cycle of rituximab was 32.4% at 12 months, or 43.1% by 36 months including additional rituximab cycles. Using receiver operating characteristic curves to develop prediction models for complete remission after a single cycle of rituximab, >90.7% reduction in average desmoglein 3 ELISA titers from baseline to months 3-9 was 94% sensitive, and an average absolute titer ≤130 RU/mL between months 3-9 was 96% specific, for achievement of complete remission off oral systemic therapy. All patients with negative titers at 6-9 months ultimately achieved complete remission off oral systemic therapy. This dataset of clinical and serological outcomes for pemphigus vulgaris patients after rituximab therapy will facilitate clinical trial planning and also guide clinician and patient expectations after rituximab therapy.
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Affiliation(s)
- Napatra Tovanabutra
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA; Department of Internal Medicine, Division of Dermatology, Chiang Mai University, Chiang Mai, Thailand
| | - Christina E Bax
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
| | - Rui Feng
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Carolyn J Kushner
- Department of Dermatology, New York University Langone Health, New York City, USA
| | - Aimee S Payne
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.
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22
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Li H, Zhao Y, Zhou L. Cutaneous manifestations in children with SARS-CoV-2 infection and/or COVID-19: what do we know after 10 months under this pandemic? Int J Dermatol 2021; 61:39-45. [PMID: 34530491 PMCID: PMC8653232 DOI: 10.1111/ijd.15882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global crisis. However, cutaneous manifestations in children with SARS-CoV-2 infection have received little attention. OBJECTIVE Our study was aimed to present clinical and cutaneous manifestations of children with SARS-CoV-2 and to provide the basis for early diagnosis. METHODS We analyzed the clinical data of COVID-19 infected (CI) children worldwide from December 2019 to October 6, 2020, by using search terms "COVID-19," "SARS-CoV-2," "Coronavirus" in combination with "cutaneous," "lesion," "rash," "skin," "dermatology," "epidermis," "dermis," "multisystem inflammatory syndrome." We collected and analyzed the general information, clinical symptoms, cutaneous manifestations, laboratory examination results, history of close contact with CI patients or suspected CI patients, and outcome in CI children. RESULTS Among 90 CI children, there were 46 boys (59%) and 32 girls (41%). Erythema was the most frequent lesion, followed by conjunctivitis, and edematous lesions. Face was the most commonly affected location including lips, conjunctivae, tongue, eyes, and eyelids. Sixty-three (73.3%) patients had multisystem inflammatory syndrome (MIS-C). As for clinical symptoms, 70 (81.4%) CI children suffered fever, and 34 (39.5%) patients had lung involvement. Meanwhile, 65.1% of patients had cardiac involvement, 4.7% of patients were asymptomatic, and 71.6% of patients received intravenous immunoglobulin, as well as 31.1% of CI children received systemic corticosteroids. Three children were dead. The most frequent route of infection was familial clustering. As silent virus carriers of CI children, it is important to find out the clinical and cutaneous manifestations in CI children to prevent and control COVID-19 transmission.
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Affiliation(s)
- Hongxin Li
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yong Zhao
- Department of Reproductive Medicine,Senior Department of Obstetrics & Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Lin Zhou
- Department of Clinical Laboratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
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23
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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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24
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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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25
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Hébert V, Maho-Vaillant M, Golinski ML, Petit M, Riou G, Boyer O, Musette P, Calbo S, Joly P. Modifications of the BAFF/BAFF-Receptor Axis in Patients With Pemphigus Treated With Rituximab Versus Standard Corticosteroid Regimen. Front Immunol 2021; 12:666022. [PMID: 34054835 PMCID: PMC8160507 DOI: 10.3389/fimmu.2021.666022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
The efficacy of the B-cell-depleting agent rituximab has been reported in immune diseases but relapses are frequent, suggesting the need for repeated infusions. The B-cell activating factor (BAFF) is an important factor for B cell survival, class switch recombination and selection of autoreactive B cells, as well as maintaining long-lived plasma cells. It has been hypothesized that relapses after rituximab might be due to the increase of serum BAFF levels. From the Ritux3 trial, we showed that baseline serum BAFF levels were higher in pemphigus patients than in healthy donors (308 ± 13 pg/mL versus 252 ± 28 pg/mL, p=0.037) and in patients with early relapse compared who didn't (368 ± 92 vs 297 ± 118 pg/mL, p=0.036). Rituximab and high doses of CS alone have different effects on the BAFF/BAFF-R axis. Rituximab led to an increase of BAFF levels associated to a decreased mRNA (Day 0: 12.3 ± 7.6 AU vs Month 36: 3.3 ± 4.3 AU, p=0.01) and mean fluorescence intensity of BAFF-R in non-autoreactive (Day 0: 3232 vs Month 36: 1527, mean difference: 1705, 95%CI: 624 to 2786; p=0.002) as well as on reappearing autoreactive DSG-specific B cells (Day 0: 3873 vs Month 36: 2688, mean difference: 1185, 95%CI: -380 to 2750; p=0.20). Starting high doses of corticosteroids allowed a transitory decrease of serum BAFF levels that re-increased after doses tapering whereas it did not modify BAFF-R expression in autoreactive and non-autoreactive B cells. Our results suggest that the activation of autoreactive B cells at the onset of pemphigus is likely to be related to the presence of high BAFF serum levels and that the decreased BAFF-R expression after rituximab might be responsible for the delayed generation of memory B cells, resulting in a rather long period of mild pemphigus activity after rituximab therapy. Conversely, the incomplete B cell depletion and persistent BAFF-R expression associated with high BAFF serum levels might explain the high number of relapses in patients treated with CS alone.
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Affiliation(s)
- Vivien Hébert
- Normandie University, UNIROUEN, Inserm, U1234, FOCIS Center of Excellence PAn'THER, Rouen University Hospital, Department of Immunology and Biotherapy, Rouen, France.,Department of Dermatology, French Reference Center for Auto Immune Blistering Diseases, Rouen University Hospital, Normandie University, Rouen, France
| | - Maud Maho-Vaillant
- Normandie University, UNIROUEN, Inserm, U1234, FOCIS Center of Excellence PAn'THER, Rouen University Hospital, Department of Immunology and Biotherapy, Rouen, France.,Department of Dermatology, French Reference Center for Auto Immune Blistering Diseases, Rouen University Hospital, Normandie University, Rouen, France
| | - Marie-Laure Golinski
- Normandie University, UNIROUEN, Inserm, U1234, FOCIS Center of Excellence PAn'THER, Rouen University Hospital, Department of Immunology and Biotherapy, Rouen, France.,Department of Dermatology, French Reference Center for Auto Immune Blistering Diseases, Rouen University Hospital, Normandie University, Rouen, France
| | - Marie Petit
- Normandie University, UNIROUEN, Inserm, U1234, FOCIS Center of Excellence PAn'THER, Rouen University Hospital, Department of Immunology and Biotherapy, Rouen, France
| | - Gaëtan Riou
- Normandie University, UNIROUEN, Inserm, U1234, FOCIS Center of Excellence PAn'THER, Rouen University Hospital, Department of Immunology and Biotherapy, Rouen, France
| | - Olivier Boyer
- Normandie University, UNIROUEN, Inserm, U1234, FOCIS Center of Excellence PAn'THER, Rouen University Hospital, Department of Immunology and Biotherapy, Rouen, France
| | - Philippe Musette
- Paris Sorbonne North University INSERM UMR 1125 and Dermatology Department Avicenne University Hospital, Bobigny, France
| | - Sébastien Calbo
- Normandie University, UNIROUEN, Inserm, U1234, FOCIS Center of Excellence PAn'THER, Rouen University Hospital, Department of Immunology and Biotherapy, Rouen, France
| | - Pascal Joly
- Normandie University, UNIROUEN, Inserm, U1234, FOCIS Center of Excellence PAn'THER, Rouen University Hospital, Department of Immunology and Biotherapy, Rouen, France.,Department of Dermatology, French Reference Center for Auto Immune Blistering Diseases, Rouen University Hospital, Normandie University, Rouen, France
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26
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Woillard JB, Assikar S, Monchaud C, Couraud A, Marquet P, Bédane C. Towards therapeutic drug monitoring of mycophenolic acid in mucous membrane pemphigoid: A retrospective single-centre study. Fundam Clin Pharmacol 2021; 35:1179-1187. [PMID: 33914391 DOI: 10.1111/fcp.12688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycophenolate mofetil (MMF) is theoretically a treatment of choice for mucous membrane pemphigoid (MMP), due to its good long-term tolerance and efficacy especially in elderly patients. However, no therapeutic monitoring is currently performed despite its large inter-individual variability. OBJECTIVES The aim of this study was to investigate the exposure/effect relationship based on the area under the curve (AUC) or trough level of mycophenolic acid in MMP patients. METHODS Thirteen patients (n = 29 AUC measurements performed between February 2013 and November 2016) treated for MMP at Limoges University Hospital were evaluated using the Mucous Membrane Pemphigoid Disease Area Index score, and patients were classified as improvement (>50% decrease vs. baseline) vs. stabilisation (<50%) or non-response (no improvement). AUC was estimated using a population pharmacokinetic model and Bayesian estimation. The association between exposure parameters, demographic variables and response group was investigated using time-dependent Cox models, and an AUC threshold for 'improvement' was also investigated. RESULTS An improvement was observed in approximately 70% of the patients. Only the MPA AUC0-24 h was retained in the multivariate analysis with a decreased risk of stabilisation/non-response per 10 mg*h/L increase, (HR = 0.64, 95% CI = [0.43-0.94], P = 0.0038). That led to an AUC0-24 h threshold of 89 mg*h/L associated with excellent performances (AUC ROC = 0.828, Sen = 75%, Spe = 100%, P = 0.0001). DISCUSSION/CONCLUSION An association between MPA exposure and disease was observed. Therapeutic drug monitoring can be proposed with an AUC0-24 h threshold of 89 mg*h/L. It might improve the long-term response of patients to this drug with better tolerance than rituximab or cyclophosphamide.
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Affiliation(s)
- Jean-Baptiste Woillard
- INSERM U1248 IPPRITT, Univ. Limoges, Limoges, France.,Department of Pharmacology and Toxicology, CHU Limoges, Limoges, France
| | - Safae Assikar
- INSERM U1248 IPPRITT, Univ. Limoges, Limoges, France.,Department of Dermatology, CHU Limoges, National Reference Center for Bullous Diseases, Limoges, France
| | - Caroline Monchaud
- INSERM U1248 IPPRITT, Univ. Limoges, Limoges, France.,Department of Pharmacology and Toxicology, CHU Limoges, Limoges, France
| | - Amélie Couraud
- Department of Dermatology, CHU Limoges, National Reference Center for Bullous Diseases, Limoges, France
| | - Pierre Marquet
- INSERM U1248 IPPRITT, Univ. Limoges, Limoges, France.,Department of Pharmacology and Toxicology, CHU Limoges, Limoges, France
| | - Christophe Bédane
- INSERM U1248 IPPRITT, Univ. Limoges, Limoges, France.,Department of Dermatology, CHU Limoges, National Reference Center for Bullous Diseases, Limoges, France
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27
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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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Intraepithelial autoimmune bullous dermatoses disease activity assessment and therapy. J Am Acad Dermatol 2021; 84:1523-1537. [PMID: 33684497 DOI: 10.1016/j.jaad.2021.02.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 12/30/2022]
Abstract
Intraepithelial autoimmune blistering dermatoses are a rare group of skin disorders characterized by disruptions of inter-keratinocyte connections within the epidermis through the action of autoantibodies. The second article in this continuing medical education series presents validated disease activity scoring systems, serologic parameters of disease, treatments, and clinical trials for pemphigus and its subtypes.
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Bieber K, Kridin K, Emtenani S, Boch K, Schmidt E, Ludwig RJ. Milestones in Personalized Medicine in Pemphigus and Pemphigoid. Front Immunol 2021; 11:591971. [PMID: 33505392 PMCID: PMC7829330 DOI: 10.3389/fimmu.2020.591971] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Pemphigus and pemphigoid diseases are autoimmune bullous diseases characterized and caused by autoantibodies targeting adhesion molecules in the skin and/or mucous membranes. Personalized medicine is a new medical model that separates patients into different groups and aims to tailor medical decisions, practices, and interventions based on the individual patient`s predicted response or risk factors. An important milestone in personalized medicine in pemphigus and pemphigoid was achieved by verifying the autoimmune pathogenesis underlying these diseases, as well as by identifying and cloning several pemphigus/pemphigoid autoantigens. The latter has become the basis of the current, molecular-based diagnosis that allows the differentiation of about a dozen pemphigus and pemphigoid entities. The importance of autoantigen-identification in pemphigus/pemphigoid is further highlighted by the emergence of autoantigen-specific B cell depleting strategies. To achieve this goal, the chimeric antigen receptor (CAR) T cell technology, which is used for the treatment of certain hematological malignancies, was adopted, by generating chimeric autoantigen receptor (CAAR) T cells. In addition to these more basic science-driven milestones in personalized medicine in pemphigus and pemphigoid, careful clinical observation and epidemiology are again contributing to personalized medicine. The identification of clearly distinct clinical phenotypes in pemphigoid like the non-inflammatory and gliptin-associated bullous pemphigoid embodies a prominent instance of the latter. We here review these exciting developments in basic, translational, clinical, and epidemiological research in pemphigus and pemphigoid. Overall, we hereby aim to attract more researchers and clinicians to this highly interesting and dynamic field of research.
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Affiliation(s)
- Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Shirin Emtenani
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Katharina Boch
- Department of Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
- Department of Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Ralf J. Ludwig
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
- Department of Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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Mahmoudi H, Tavakolpour S, Balighi K, Farid AS, Nili A, Jan D, Daneshpazhooh M. Rituximab in practice: Clinical evaluation of patients with pemphigus after rituximab administration. Dermatol Ther 2020; 34:e14633. [PMID: 33280226 DOI: 10.1111/dth.14633] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022]
Abstract
Pemphigus Vulgaris (PV) is a rare autoimmune blistering disease, which mainly causes mucosal and/or cutaneous lesions. In June 2018, FDA approved Rituximab (RTX)-a B-cell depleting agent-for the management of patients with moderate-to-severe pemphigus. Although the majority of patients respond well to this drug, some do not reach complete remission with a single cycle of RTX. In this review, following an overview of RTX and its clinical outcomes, we have focused on the possible outcomes after RTX therapy in patients with PV. The response is defined into four main categories; complete responders, partial responders, nonresponders, and paradoxical reactions, based on three possibilities of reaching the consolidation phase after 3 months, reaching remission until 6 months, and the ability of corticosteroid tapering in 6 months after RTX administration. Concerning the safety of RTX, three categories of infusion reactions, short and long-term side effects are discussed. Additionally, we have suggested approaches for the evaluation of clinical and serological responses at different critical time-points, including 1, 2, 3, and 6 months after RTX administration. Finally, available markers to predict the response to RTX and research gaps in the field of RTX therapy have been summarized.
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Affiliation(s)
- 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.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Delnavaz Jan
- 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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D’Incan PM. Quoi de neuf en Clinique en 2020 ? Ann Dermatol Venereol 2020; 147:12S1-12S8. [DOI: 10.1016/s0151-9638(20)31101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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32
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Quoi de neuf en thérapeutique dermatologique ? Ann Dermatol Venereol 2020; 147:12S43-12S50. [DOI: 10.1016/s0151-9638(20)31107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lemieux A, Joly P. Reader Comment on "Rituximab Lymphoma-Protocol May Be Superior for Inducing Remission in Pemphigus Vulgaris". J Cutan Med Surg 2020; 25:111-112. [PMID: 33142071 DOI: 10.1177/1203475420972366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alexandre Lemieux
- 25443 Department of Medicine, Division of Dermatology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Pascal Joly
- 55052 Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Centre Hospitalier Universitaire de Rouen, 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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Li H, Zhao Y, Zhou L, Hu J. Cutaneous, skin histopathological manifestations and relationship to COVID-19 infection patients. Dermatol Ther 2020; 33:e14157. [PMID: 32770717 PMCID: PMC7435499 DOI: 10.1111/dth.14157] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
COVID-19 diseases have been a nationwide pandemic condition. However, cutaneous, skin histopathological manifestations of COVID-19 infection are not well described. Our study aims are to present heterogeneous cutaneous, histopathological manifestations in COVID-19 patients, to investigate the possible relationship between cutaneous manifestations and histopathological features in COVID-19 infection. We performed a systemic review in PubMed database and Chinese medical journal search engines which were wangfang.data (http://www.wanfangdata.com.cn/), Science China (http://www.cnki.net/) until June 17th, 2020. Search terms "COVID-19," "SARS-Coronavirus-2" and "Coronavirus" were used in combination with "cutaneous," "rash," "skin," "dermatology." Seventy-five papers were included with confirmed COVID-19 infection. The most frequent cutaneous manifestation of COVID-19 present was erythema, nearly 38.4%. Trunk was the most affected location, presenting in 51.4% patients. Rash occurred before onset of other symptoms was in 5.3% patients. Seventy-seven patients were received treatments. Rash was dismissed in 49% patients, improved in 21.2% patients ranged from 0 to 17 days. The histopathological examination present in 39 patients. Skin is one of target organs affected by COVID-19 infection. Cutaneous manifestations should be paid more attention. It can help doctors diagnose COVID-19 infection in prodromal stage, understand progression, and determine prognosis of COVID-19 infection.
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Affiliation(s)
- Hongxin Li
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yong Zhao
- The Sixth Medical Centre of PLA, General Hospital, Beijing, China
| | - Lin Zhou
- Department of Clinical Laboratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Jin Hu
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
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Joly P, Horvath B, Patsatsi Α, Uzun S, Bech R, Beissert S, Bergman R, Bernard P, Borradori L, Caproni M, Caux F, Cianchini G, Daneshpazhooh M, De D, Dmochowski M, Drenovska K, Ehrchen J, Feliciani C, Goebeler M, Groves R, Guenther C, Hofmann S, Ioannides D, Kowalewski C, Ludwig R, Lim Y, Marinovic B, Marzano A, Mascaró J, Mimouni D, Murrell D, Pincelli C, Squarcioni C, Sárdy M, Setterfield J, Sprecher E, Vassileva S, Wozniak K, Yayli S, Zambruno G, Zillikens D, Hertl M, Schmidt E. Updated S2K guidelines on the management of pemphigus vulgaris and foliaceus initiated by the european academy of dermatology and venereology (EADV). J Eur Acad Dermatol Venereol 2020; 34:1900-1913. [DOI: 10.1111/jdv.16752] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/29/2020] [Indexed: 01/21/2023]
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