Rituximab as first line: an advent in pemphigus
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20190249Keywords:
Pemphigus vulgaris, Rituximab, HACA, PlasmapheresisAbstract
Rituximab is a newly approved biological wonder drug in pemphigus vulgaris -an autoimmune mucocutaneous blistering disease due to antibodies produced against the epidermal adhesion molecules dsg 1 and dsg 2. The conventional therapy included high dose steroids or immunosuppressants that though effective had significant adverse effects that necessitated an alternate path in treatment. We present a case series of five patients in different clinical scenarios diagnosed with pemphigus vulgaris and treated with Rituximab by RA protocol either sole or in combination with other treatment strategies. Our experience with this drug has paved way to immense possibilities and outcomes that are in favour of using Rituximab as first line option. We have encountered prolonged remission in cases that were treated with Rituximab by Rheumatoid arthritis (RA) protocol. The sustained response has helped in reducing the dose of steroids and other immunosuppressants substantially. These facts are reinforced through our observations. But there is need to standardize the dosage of Rituximab in pemphigus.
References
Spindler V, Endlich A, Hartlieb E, Vielmuth F, Schmidt E, Waschke J. The Extent of Desmoglein 3 Depletion in Pemphigus Vulgaris Is Dependent on Ca2+-Induced Differentiation- A Role in Suprabasal Epidermal Skin Splitting. Am J Pathol. 2011;179(4):1905–16.
Emer JJ, Claire W. Rituximab - A Review of Dermatological Applications. J Clin Aesthet Dermatol. 2009;2:29–37.
Zakka LR, Shetty SS, Ahmed AR. Rituximab in the Treatment of Pemphigus Vulgaris. Dermatol Ther (Heidelb). 2012;2(1):17.
Kanwar AJ, Vinay K. Rituximab in pemphigus. Indian J Dermatol Venereol Leprol. 2012;78:671-6.
Cholera M, Chainani-Wu N. Management of Pemphigus Vulgaris. Adv Ther. 2016;33:910–58.
Gregoriou S, Efthymiou O, Stefanaki C, Rigopoulos D. Management of pemphigus vulgaris: challenges and solutions. Clin Cosmet Investig Dermatol. 2015;8:521–7.
Anandan V, Jameela WA, Sowmiya R, Surya Kumar MM, Lavanya P. Rituximab: A Magic Bullet for Pemphigus. J Clin Diagn Res. 2017;11(4):1–6.
Joly P, Mouquet H, Roujeau JC, D'Incan M, Gilbert D, Jacquot S, et al. A single cycle of rituximab for the treatment of severe pemphigus. N Engl J Med. 2007;357:545-52.
Gupta J, Raval RC, Shah AN, Solanki RB, Patel DD, Shah KB, et al. Low-dose rituximab as an adjuvant therapy in pemphigus. Indian J Dermatol Venereol Leprol. 2017;83:317-25.
Kumar R, Jindal A, Kaur A, Gupta S. Therapeutic Plasma Exchange-A New Dawn in the Treatment of Pemphigus Vulgaris. Indian J Dermatol. 2015;60:419.
Albert D, Dunham J, Khan S, Stansberry J, Kolasinski S, Tsai D, et al. Variability in the biological response to anti-CD20 B cell depletion in systemic lupus erythaematosus. Ann Rheum Dis 2008;67(12):1724-31.
Kasperkiewicz M, Ellebrecht CT, Takahashi H, Yamagami J, Zillikens D, Payne AS. Pemphigus. Nat Rev Dis Primers. 2017;3:17026.
Looney RJ, Anolik JH, Campbell D, Felgar RE, Young F, Arend LJ, et al. B cell depletion as a novel treatment for systemic lupus erythematosus: a phaseI/II dose-escalation trial of rituximab. Arthritis Rheum. 2004;50:2580-9.
Lunardon L, Payne AS. Rituximab for autoimmune blistering diseases: recent studies, new insights. G Ital Dermatol Venereol. 2012;147:269-76.
Tan-Lim R, Bystryn JC. Effect of plasmapheresis therapy on circulating levels of pemphigus antibodies. J Am Acad Dermatol. 1990;22:35-40.
Ostrowski RA, Bussey MR, Shayesteh Y, Jay WM. Rituximab in the Treatment of Thyroid Eye Disease: A Review. Neuroophthalmology. 2015;39:109–15.
Leonardi CL, Heffernan MP, Gill JG. Rituximab and future biological therapies. In: Wolverton SE, editor. Comprehensive Dermatologic Drug Therapy, 3rd ed. Indianapolis: Elsevier Publishers; 2013: 334.
Payet S, Soubrier M, Perrodeau E, Bardin T, Cantagrel A, Combe B, et al. Efficacy and safety of rituximab in elderly patients with rheumatoid arthritis enrolled in a French Society of Rheumatology registry. Arthritis Care Res (Hoboken). 2014;66:1289-95.
Levin AS, Otani IM, Lax T, Hochberg E, Banerji A. Reactions to Rituximab in an Outpatient Infusion Center: A 5-Year Review. J Allergy Clin Immunol Pract. 2017;5(1):107-13.
Emer JJ, Claire W. Rituximab A Review of Dermatological Applications. J Clin Aesthet Dermatol. 2009;2(5):29–37.
Tsuji H, Yoshifuji H, Fujii T, Matsuo T, Nakashima R, Imura Y, et al. Visceral disseminated varicella zoster virus infection after rituximab treatment for granulomatosis with polyangiitis. Mod Rheumatol. 2017;27:155-61.
Kanchan R, Kamoji SG, Patil MN. To Compare the Cost of Rituximab and DCP Therapy in Pemphigus in a Government Tertiary Hospital. J Clin Exp Dermatol Res. 2017;8:2.
