Rituximab Helps with Refractory Pemphigus Vulgaris

Rituximab plus intravenous immune globulin leads to dramatic, lasting remission

WEDNESDAY, Oct. 25 (HealthDay News) -- Intravenous immune globulin combined with 10 infusions of rituximab during a five-month period can quickly and safely induce remission among patients with refractory pemphigus vulgaris, according to a study published in the Oct. 26 issue of the New England Journal of Medicine.

A. Razzaque Ahmed, M.D., of the New England Baptist Hospital in Boston, and colleagues treated 11 patients with limited or incomplete response to conventional treatment (high-dose corticosteroids, immunosuppressive agents and intravenous immune globulin) with rituximab plus intravenous immune globulin.

Nine patients showed rapid resolution of lesions and a clinical remission lasting 22 to 37 months. Two patients experienced disease recurrence and were successfully treated with rituximab monotherapy. Remission status correlated with reduction in titers of pathogenic IgG4 antikeratinocyte antibodies and a transient elimination of B-cells. While the long-term consequences of rituximab in patients with autoimmune disease are unknown, it appeared safe in this study.

"We believe that the dramatic and rapid clinical responses we observed can be attributed to rituximab and possibly to synergistic effects of intravenous immune globulin," the authors conclude.

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