Treatment of Pemphigus with Rituximab: Real-Life Experience in a Cohort of 117 Patients in Israel

Background: A combined regimen of rituximab with corticosteroids for the treatment of pemphigus was effective in a prospective randomized controlled trial. Objective: To assess real-life response to rituximab in patients with pemphigus. Methods: A retrospective cohort of patients with pemphigus treated with >= 1 rituximab cycles (1,000 mg on days 0 and 14). The primary outcome was remission rate after 1 cycle. For efficacy analyses, a minimal 6-month follow-up was required. Adverse events were assessed in all patients. Results: The cohort included 117 patients for safety analysis, 108 for efficacy analysis (median follow-up of 33 months). All but one received concomitant corticosteroids, a third also received adjuvants. Overall, 80/108 patients (74%) achieved remission after the first rituximab cycle at a median of 5.5 months. Relapses occurred in 39 patients (49%) at a median of 18 months. Repeating treatment in relapsed patients increased remission rates to 75 and 88% after the second and third cycles, respectively. Adverse events were similar to those of previous publications. Two elderly patients died of infections attributable to rituximab combined with high-dose corticosteroids. Conclusion: In a large real-life long-term cohort, rituximab with corticosteroids +/- adjuvants induced remission in most patients with pemphigus, with relatively favorable safety. Repeating treatment following relapse or remission failure was beneficial.

Automated summary

A combination of rituximab and corticosteroids shows efficacy in inducing remission in most pemphigus patients in real-life settings, with certain patients experiencing relapses. Repeating treatment for relapsed patients can increase remission rates, with adverse events similar to previous studies.