Rituximab – An effective first line treatment in pemphigus vulgaris patients

Abstract

: Rituximab is a humanized chimeric anti-CD20 monoclonal antibody that quickly lowers blood serum levels of anti-desmoglein autoantibodies, causing pemphigus lesions to heal. To evaluate the efficacy of Rituximab in treating pemphigus vulgaris. : We identified and included 14 patients (3 males and 11 females), in the age group of 14 years to 67 years, of severe pemphigus vulgaris from 2016 to 2022 treated at our institution with rituximab infusion in our retrospective case study. Baseline anti-desmoglein antibodies 1 and 3 levels were elevated in all the patients. 12 of these patients received rituximab infusion as first-line treatment. 11(out of 14) patients received two doses of rituximab (1 gram in each) as intravenous infusions, as per the rheumatoid arthritis protocol; whereas, 3 (out of 14) received a single dose of intravenous rituximab infusion (1 gram). These patients were kept on maintenance dose of prednisolone/ mycophenolate mofetil post rituximab infusion. : 14 patients of pemphigus vulgaris were enrolled in the study. The follow-up period ranged from 2 months to 6 years. All 14 patients responded well to therapy. No serious adverse events were observed. 10 (71.4%) of the 14 patients exhibited complete remission; whereas, 4 (28.6%) showed partial remission. Those with partial remission experienced relapse but the subsequent episode was less severe than the first episode. However, 2 patients who were non-responders to high doses of systemic steroids expired. : For treating patients with pemphigus vulgaris, rituximab infusion was found to be safe and effective. Hence, it should be considered as first-line for management of pemphigus vulgaris.