Efficacy of Rituximab for Pemphigus: A Systematic Review and Meta-analysis of Different Regimens

This meta-analysis examined the efficacy of different dosing regimens containing rituximab (RTX) in treating pemphigus. The analysis included 578 patients with pemphigus from 30 studies. Seventy-six percent of patients achieved complete remission after one cycle of RTX. Mean time to remission was 5.8 months, with a remission duration of 14.5 months and a 40% relapse rate. Eighteen patients (3.3%) developed serious adverse effects. The pooled estimate showed no significant differences in complete remission and relapse rates between patients treated with high-dose (near or >= 2,000 mg/cycle) vs. low-dose (<1,500 mg/cycle) RTX. In the fully adjusted analysis, high-dose RTX was associated with longer duration of complete remission compared with low-dose RTX. No superiority of lymphoma protocol over rheumatoid arthritis or high-dose RTX over low-dose RTX was shown in other outcomes. RTX treatment is efficacious and well-tolerated in treating pemphigus. High-dose RTX treatment may lead to longer duration of remission. However, the choice of optimal regimen depends on the overall condition of the individual patient.