1
|
Khan A, Singh A, Madke B, Bhatt DM, Jangid SD. A Comprehensive Review on the Efficacy of Anti-CD20 Therapies in Pemphigus Treatment. Cureus 2024; 16:e58834. [PMID: 38784354 PMCID: PMC11114485 DOI: 10.7759/cureus.58834] [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: 03/29/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Pemphigus, an autoimmune blistering disorder, poses significant therapeutic challenges due to dysregulated B cells and the involvement of CD20. This review assesses the efficacy of anti-CD20 therapies, including rituximab, ofatumumab, ocrelizumab, and obinutuzumab, in pemphigus treatment. Mechanisms of action, clinical studies, and safety profiles were analyzed, revealing diverse impacts on disease severity. B cell depletion emerged as a pivotal factor, disrupting the autoimmune process and reducing pathogenic antibodies. Varied efficacy and safety profiles among agents underscore the need for personalized treatment strategies guided by biomarkers. Challenges such as resistance and long-term safety concerns necessitate continued research and vigilance. In clinical practice, insights from this review inform nuanced, tailored approaches for improved pemphigus management. The dynamic landscape of emerging therapies and personalized medicine emphasizes the need for ongoing research and strategic clinical decision-making. This review is a foundation for future investigations, providing insights for clinicians and researchers in optimizing pemphigus treatment.
Collapse
Affiliation(s)
- Arshiya Khan
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Adarshlata Singh
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Bhushan Madke
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, IND
| | - Drishti M Bhatt
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, IND
| | - Shivani D Jangid
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, IND
| |
Collapse
|
3
|
Gambichler T, Lee YP, Oschlies I, Scheel CH, Klapper W, Nowack N, Doerler M, Stücker M, Abolmaali N, Susok L. Antibody-Negative Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) in a Patient with Follicular Lymphoma Accompanied by an Excess of Peripheral Blood CD8+ Lymphocytes. Curr Oncol 2022; 29:2395-2405. [PMID: 35448168 PMCID: PMC9032549 DOI: 10.3390/curroncol29040194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Paraneoplastic autoimmune multiorgan syndrome (PAMS) is a life-threatening autoimmune disease associated with malignancies. Here, we present a patient initially misdiagnosed with “chronic” Stevens–Johnson syndrome. Over a year later, the patient was diagnosed with stage IV follicular lymphoma and treated with an anti-CD20 antibody. At this time, his skin condition had significantly worsened, with erythroderma and massive mucosal involvement, including in the mouth, nose, eyes, and genital region. Histopathology revealed lichenoid infiltrates with interface dermatitis, dyskeratoses, necrotic keratinocytes, and a dense CD8+ infiltrate with strong epidermotropism. Direct and indirect immunofluorescence tests for autoantibodies were negative. Remarkably, we retrospectively discovered a chronic increase in peripheral CD8+ lymphocytes, persisting for over a year. Consequently, the patient was diagnosed with antibody-negative PAMS. Three weeks later, he succumbed to respiratory failure. This dramatic case highlights the challenges in diagnosing PAMS, particularly in cases where immunofluorescence assays are negative. Importantly, we observed, for the first time, a chronic excess of CD8+ peripheral blood lymphocytes, associated with PAMS, consistent with the systemic, autoreactive T-cell-driven processes that characterize this condition.
Collapse
Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (Y.-P.L.); (C.H.S.); (N.N.); (M.D.); (M.S.); (L.S.)
- Correspondence:
| | - Yi-Pei Lee
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (Y.-P.L.); (C.H.S.); (N.N.); (M.D.); (M.S.); (L.S.)
| | - Ilske Oschlies
- Hematopathology Section and Lymph Node Registry, Institute of Pathology, University Hospital Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, 24105 Kiel, Germany; (I.O.); (W.K.)
| | - Christina H. Scheel
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (Y.-P.L.); (C.H.S.); (N.N.); (M.D.); (M.S.); (L.S.)
| | - Wolfram Klapper
- Hematopathology Section and Lymph Node Registry, Institute of Pathology, University Hospital Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, 24105 Kiel, Germany; (I.O.); (W.K.)
| | - Nico Nowack
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (Y.-P.L.); (C.H.S.); (N.N.); (M.D.); (M.S.); (L.S.)
| | - Martin Doerler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (Y.-P.L.); (C.H.S.); (N.N.); (M.D.); (M.S.); (L.S.)
| | - Markus Stücker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (Y.-P.L.); (C.H.S.); (N.N.); (M.D.); (M.S.); (L.S.)
| | - Nasreddin Abolmaali
- Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, Ruhr-University Bochum, 44791 Bochum, Germany;
| | - Laura Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (Y.-P.L.); (C.H.S.); (N.N.); (M.D.); (M.S.); (L.S.)
| |
Collapse
|