Rituximab in the Treatment of Pemphigus Vulgaris – Case Report
Authors:
O. Kodet 1,2,3; L. Lacina 1,2,3; Z. Plzáková 1; I. Krajsová 1; J. Štork 1
Authors‘ workplace:
Dermatovenerologická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. Jiří Štork, CSc.
1; Anatomický ústav 1. LF UK, Praha, přednosta prof. MUDr. Karel Smetana, DrSc.
2; BIOCEV – Biotechnologické a biomedicínské centrum Akademie věd a Univerzity Karlovy ve Vestci u Prahy, ředitel prof. MUDr. Pavel Martásek, DrSc.
3
Published in:
Čes-slov Derm, 95, 2020, No. 3, p. 108-114
Category:
Case interpretation
Overview
The authors describes a case of a 18-year-old patient suffering from pemphigus vulgaris in whom adjuvant therapy with rituximab has been initiated due to the protracted course of treatment, frequent exacerbations of the disease, development of multiple complications during long-term systemic corticosteroid therapy and ineffective prior adjuvant therapy (azathioprine, cyclophosphamide, mycophenolate mofetil). Currently, the described patient has been in complete remission of the disease for 21 months only with supportive osteoporosis therapy. Rituximab is a chimeric (murine/human) monoclonal antibody targeting B cell surface receptor CD20 and has been newly introduced to the first line of systemic therapy of pemphigus and induced good therapeutic response and steroid-sparing effect in clinical trials. The authors present an overview of current knowledge about the treatment of this disease with rituximab.
Keywords:
rituximab – pemphigus vulgaris – desmoglein 1 and 3 – CD19 positive B-lymphocytes
Sources
1. ABASQ, C., MOUQUET, H., GILBERT, D. et al. ELISA testing of anti-desmoglein 1 and 3 antibodies in the management of pemphigus. Arch. Dermatol., 2009, 145(5), p. 529–535.
2. ALBERS, L. N., LIU, Y., BO, N. et al. Developing biomarkers for predicting clinical relapse in pemphigus patients treated with rituximab. J. Am. Acad. Dermatol., 2017, 77(6), p. 1074–1082.
3. BENEDEK, T. G. History of the development of corticosteroid therapy. Clin. Exp. Rheumatol., 2011, 29(5 SUPPL. 68).
4. BILGIC, A., MURRELL, D. F. What is novel in the clinical management of pemphigus. Expert Review of Clinical Pharmacology, 2019, 12(10), p. 973–980.
5. BOLETO, G., AVOUAC, J., WIPFF, J. et al. Predictors of hypogammaglobulinemia during rituximab maintenance therapy in rheumatoid arthritis: A 12-year longitudinal multi-center study. Semin. Arthritis Rheum., 2018, 48(2), p. 149–154.
6. DUPUY, A., VIGUIER, M., BÉDANE, C. et al., Treatment of Refractory Pemphigus Vulgaris with Rituximab (Anti-CD20 Monoclonal Antibody). Arch. Dermatol., 2004, 140(1), p. 91–96.
7. ELLEBRECHT, C. T., CHOI, E. J., ALLMAN, D. M. et al. Subcutaneous Veltuzumab, a Humanized Anti-CD20 Antibody, in the Treatment of Refractory Pemphigus Vulgaris. JAMA Dermatology, 2014, 150(12), p. 1331–1335.
8. GOLDBLATT, F., ISENBERG, D. A. New therapies for rheumatoid arthritis. Clinical and Experimental Immunology, 2005, 140(2), p. 195–204.
9. GOH, M. S. Y., McCORMACK, C., DINH, H. V. et al., Rituximab in the adjuvant treatment of pemphigus vulgaris: A prospective open-label pilot study in five patients. Br. J. Dermatol., 2007, 156(5), p. 990–996.
10. HARMAN, K. E., BROWN, D., EXTON, L. S. et al., British Association of Dermatologists’ guidelines for the management of pemphigus vulgaris 2017. Br. J. Dermatol., 2017, 177(5), p. 1170–1201.
11. HEIZMANN, M., ITIN, P., WERNLI, M. et al., Successful treatment of paraneoplastic pemphigus in follicular NHL with rituximab: Report of a case and review of treatment for paraneoplastic pemphigus in NHL and CLL. Am. J. Hematol., 2001, 66(2), p. 142–144.
12. HORVÁTH, B., HUIZINGA, J., PAS, H. H. et al. Low-dose rituximab is effective in pemphigus. Br. J. Dermatol., 2012, 166(2), p. 405–412.
13. HUANG, Y.-H., KUO, C.-F., CHEN, Y.-H. et al. Incidence, mortality, and causes of death of patients with pemphigus in Taiwan: a nationwide population-based study. J. Invest. Dermatol., 2012, 132(1), p. 92–97.
14. CHEN, D. M., ODUEYUNGBO, A., CSINADY, E. et al. Rituximab is an effective treatment in patients with pemphigus vulgaris and demonstrates a steroid-sparing effect. Br. J. Dermatol., 2019.
15. JOHNSON, P., GLENNIE, M. The mechanisms of action of rituximab in the elimination of tumor cells. Seminars in Oncology, 2003, 30(1 SUPPL. 2), p. 3–8.
16. JOLY, P., MAHO-VAILLANT, M., PROST-SQUARCIONI, C. et al. First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial. Lancet, 2017, 389(10083), p. 2031–2040.
17. KANWAR, A. J., VINAY, K., SAWATKAR, G. U. et al. Clinical and immunological outcomes of high- and low-dose rituximab treatments in patients with pemphigus: A randomized, comparative, observer-blinded study. Br. J. Dermatol., 2014, 170(6), p. 1341–1349.
18. KRIDIN, K. Pemphigus group: overview, epidemiology, mortality, and comorbidities. Immunologic Research, 2018, 66(2), p. 255–270.
19. KRIDIN, K., SAGI, S. Z., BERGMAN, R. Mortality and Cause of Death in Patients with Pemphigus. Acta Derm. Venereol., 2017, 97(5), p. 607–611.
20. LANGAN, S. M., SMEETH, L., HUBBARD, R. et al. Bullous pemphigoid and pemphigus vulgaris – Incidence and mortality in the UK: Population based cohort study. BMJ, 2008, 337(7662), p. 160–163.
21. LEGET, G. A., CZUCZMAN, M. S. Use of rituximab, the new FDA-approved antibody. Current Opinion in Oncology, 1998, 10(6), p. 548–551.
22. McCARTY, M., FIVENSON, D. Two decades of using the combination of tetracycline derivatives and niacinamide as steroid-sparing agents in the management of pemphigus: Defining a niche for these low toxicity agents. J. Am. Acad. Dermatol., 2014, 71(3), p. 475–479.
23. MURRELL, D. F., PEÑA, S., JOLY, P. et al. Diagnosis and management of pemphigus: Recommendations of an international panel of experts. J. Am. Acad. Dermatol., 2020.
24. PALYLYK-COLWELL, E., McGAHAN, L. Rituximab for rheumatoid arthritis. Issues Emerg. Health Technol., 2006, (89), p. 1–4.
25. PESCOVITZ, M. D. Rituximab, an anti-CD20 monoclonal antibody: History and mechanism of action. American Journal of Transplantation, 2006, 6(5 I). p. 859–866.
26. RAPP, M. B., PENTLAND, A. P., RICHARDSON, C. T. Successful treatment of pemphigus vulgaris with ofatumumab. J. Drugs Dermatology, 2018, 17(12), p. 1338–1339.
27. RAZZAQUE AHMED, A. MOY, R. Death in pemphigus. J. Am. Acad. Dermatol., 1982, 7(2), p. 221–228.
28. RUSSO, I., MIOTTO, S., SAPONERI, A. et al. Ultra-low dose rituximab for refractory pemghigus vulgaris: a pilot study. Expert Opin. Biol. Ther., 2020, p. 14712598.2020.1727440.
29. SCHMIDT, E., HUNZELMANN, N., ZILLIKENS, D. et al. Rituximab in refractory autoimmune bullous diseases. Clinical and Experimental Dermatology, 2006, 31(4). p. 503–508.
30. SCHMIDT, E., KASPERKIEWICZ, M., JOLY, P. Pemphigus. The Lancet, 2019, 394(10201), p. 882–894.
31. TROUVIN, A. P., JACQUOT, S., GRIGIONI, S. et al. Usefulness of monitoring of B cell depletion in rituximab-treated rheumatoid arthritis patients in order to predict clinical relapse: A prospective observational study. Clin. Exp. Immunol., 2015, 180(1), p. 11–18.
Labels
Dermatology & STDs Paediatric dermatology & STDsArticle was published in
Czech-Slovak Dermatology
2020 Issue 3
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