Treatment of Pemphigus Vulgaris with Rituximab

Efficacy and Combination Therapy

The British Journal of Dermatology recommends rituximab plus short-term prednisolone for pemphigus vulgaris treatment, resulting in 89% complete remission rates at 2 years 1, 2
Adjuvant systemic immunosuppressive drugs can be continued with rituximab, but dose reduction should be considered to decrease infection risk 3
Rituximab achieved sustained complete remission in 40% of patients versus 10% with mycophenolate mofetil at 52 weeks, although the specific citation for this comparison is not provided, a meta-analysis of 578 patients with pemphigus showed 76% remission rate following a single cycle of rituximab 1
Clinical responses to rituximab typically begin within 6 weeks of administration 1

For patients resistant to or intolerant of rituximab, consider immunoadsorption in combination with rituximab 4, 5
Immunoadsorption can reduce circulating desmoglein antibody levels by up to 95% when administered daily over three consecutive days 5
Novel anti-CD20 agents like veltuzumab may be beneficial in rituximab-resistant cases 3

Assess for clinical improvement, which typically occurs within days, with complete healing expected within 3-8 weeks 6
Monitor for relapse, which occurs in up to 65% of patients, typically 13-17 months after rituximab administration 1