Clinical and immunological follow-up of pemphigus patients on adjuvant treatment with immunoadsorption or rituximab.

Abstract

BACKGROUND:

Pemphigus vulgaris (PV) is a life-threatening autoimmune blistering skin disease which is associated with pathogenic IgG autoantibodies against desmogleins (Dsg) 1 and 3. Novel therapeutic strategies such as immunoadsorption (IA) or the anti-CD20 antibody rituximab (Rtx) hold promise to be effective in severe or recalcitrant PV.

PATIENTS AND METHODS:

In the present retrospective study, 6 patients with extensive cutaneous PV were subjected to adjuvant IA treatment while 5 patients with severe mucosal PV received adjuvant Rtx treatment.

RESULTS:

Within 6 months, IA and Rtx induced excellent clinical responses which were associated with a significant reduction of prednisolone doses and a decrease in anti-Dsg-specific IgG. Over a 12-month period, 3 IA-treated patients required additional adjuvant drugs while all of the PV patients on Rtx had no or only minimal residual symptoms.

CONCLUSION:

The relative therapeutic (long-term) efficacy of IA and Rtx in cutaneous versus mucosal PV needs to be evaluated in a prospective study.

• Authors: Martin Pfütze, Rüdiger Eming, Andrea Kneisel, Uwe Kuhlmann, Joachim Hoyer, Michael Hertl
• Journal: Dermatology (Basel, Switzerland) (Dermatology) Vol. 218 Issue 3 Pg. 237-45 ( 2009) ISSN: 1421-9832 [Electronic] Switzerland
• PMID: 19088461 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: 2008 S. Karger AG, Basel

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Autoantibodies
• Desmoglein 1
• Desmoglein 3
• Immunoglobulin G
• Immunologic Factors
• Rituximab

Topics

• Adult
• Aged
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Murine-Derived
• Autoantibodies (blood)
• Desmoglein 1 (immunology)
• Desmoglein 3 (immunology)
• Female
• Humans
• Immunoglobulin G (immunology)
• Immunologic Factors (therapeutic use)
• Immunosorbent Techniques
• Male
• Middle Aged
• Pemphigus (immunology, pathology, therapy)
• Rituximab