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First-line treatment of pemphigus vulgaris with a combination of rituximab and high-potency topical corticosteroids
- Source :
- JAMA dermatology. 151(2)
- Publication Year :
- 2014
-
Abstract
- Importance The main component of the first-line treatment of pemphigus vulgaris is high doses of systemic corticosteroids, but adverse effects of these drugs are frequent and sometimes severe. Rituximab has shown effectiveness as a corticosteroid-sparing agent or in case of relapse. To our knowledge, the effectiveness of rituximab as a first-line treatment without systemic corticosteroids has not been evaluated. Observations Five women in their 50s, 60s, or 70s with pemphigus vulgaris (Pemphigus Disease Area Index score, 15-84 at diagnosis) and contraindications to systemic corticosteroid treatment received rituximab with high-potency topical corticosteroids as first-line treatment. All patients experienced a favorable response, with a mean time to healing of skin and mucosal lesions of 15 weeks. Two patients, with 42- and 48-month follow-up evaluations, did not experience relapse. Three patients developed 2 to 4 relapses, with effective retreatment achieved using rituximab and topical corticosteroids. No severe adverse effects were observed. Conclusions and Relevance Considering the high rate of severe adverse effects induced by prolonged administration of high doses of systemic corticosteroids, new therapeutic options are warranted in the treatment of pemphigus vulgaris. The combination of rituximab and topical corticosteroids could be considered in mild to severe cutaneous disease. Larger long-term studies are needed to evaluate the optimal treatment strategies according to the severity of the disease and the benefit-risk ratio of rituximab.
- Subjects :
- medicine.medical_specialty
Administration, Topical
Dermatology
Antibodies, Monoclonal, Murine-Derived
Pharmacotherapy
immune system diseases
medicine
Potency
Humans
Immunologic Factors
Adverse effect
Infusions, Intravenous
Glucocorticoids
CD20
biology
business.industry
Pemphigus vulgaris
Remission Induction
Middle Aged
medicine.disease
Antigens, CD20
Pemphigus
Monoclonal
biology.protein
Rituximab
Drug Therapy, Combination
Female
business
medicine.drug
Follow-Up Studies
Subjects
Details
- ISSN :
- 21686084
- Volume :
- 151
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- JAMA dermatology
- Accession number :
- edsair.doi.dedup.....1b3fbb4f304695f8a0ad4df3d5eb755c