The prompt use of rituximab could decrease adverse effects in patient with pemphigus vulgaris: A preliminary evaluation.
oral mucosa
pemphigus
rituximab
Journal
Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology
ISSN: 1600-0714
Titre abrégé: J Oral Pathol Med
Pays: Denmark
ID NLM: 8911934
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
29
11
2019
accepted:
03
12
2019
pubmed:
6
12
2019
medline:
28
2
2020
entrez:
6
12
2019
Statut:
ppublish
Résumé
The systemic use of corticosteroid is the treatment of choice for patients with pemphigus vulgaris (PV), but adverse effects are frequent. To date, the use of rituximab (RTX) for PV patients is usually indicated when they failed first-line immunosuppressive therapies. The early use of RTX could theoretically lessen adverse effects. We performed a single-center study on patients with predominantly oral PV, treated with systemic corticosteroid and the prompt use of 1000 mg of intravenous RTX two weeks apart. We evaluated the clinical response and the reported adverse effect during a period of 24 months, comparing those with a previously published series. The study group comprised 11 patients, while the control group comprised 98 patients. The average time to achieve complete clinical remission was 3.2 ± 2.72 months. Study group took steroids for a mean time of 11.09 ± 2.02 months, and they are all actually disease-free with no medication. Only three patients (27.3%) developed plain side effects. The effect of the length of the corticosteroid therapy on the side effects (also adjusted by sex, age, and clinical oral involvement) was statistically different in the two groups: the prompt use of RTX reduced of 94% the chance to have adverse effects (P = .001). This is the first report of the use of RTX as first line of therapy for PV patients with predominantly oral involvement. With the proposed regimen, the adverse effects have been minimized compared with classic systemic corticosteroid-centered therapy. Multi-center randomized controlled trail is however necessary.
Sections du résumé
BACKGROUND
BACKGROUND
The systemic use of corticosteroid is the treatment of choice for patients with pemphigus vulgaris (PV), but adverse effects are frequent. To date, the use of rituximab (RTX) for PV patients is usually indicated when they failed first-line immunosuppressive therapies. The early use of RTX could theoretically lessen adverse effects.
METHODS
METHODS
We performed a single-center study on patients with predominantly oral PV, treated with systemic corticosteroid and the prompt use of 1000 mg of intravenous RTX two weeks apart. We evaluated the clinical response and the reported adverse effect during a period of 24 months, comparing those with a previously published series.
RESULTS
RESULTS
The study group comprised 11 patients, while the control group comprised 98 patients. The average time to achieve complete clinical remission was 3.2 ± 2.72 months. Study group took steroids for a mean time of 11.09 ± 2.02 months, and they are all actually disease-free with no medication. Only three patients (27.3%) developed plain side effects. The effect of the length of the corticosteroid therapy on the side effects (also adjusted by sex, age, and clinical oral involvement) was statistically different in the two groups: the prompt use of RTX reduced of 94% the chance to have adverse effects (P = .001).
CONCLUSIONS
CONCLUSIONS
This is the first report of the use of RTX as first line of therapy for PV patients with predominantly oral involvement. With the proposed regimen, the adverse effects have been minimized compared with classic systemic corticosteroid-centered therapy. Multi-center randomized controlled trail is however necessary.
Substances chimiques
Immunologic Factors
0
Immunosuppressive Agents
0
Rituximab
4F4X42SYQ6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
177-180Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
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Ojaimi S, O'Connor K, Lin MW, Schifter M, Fulcher DA. Treatment outcomes in a cohort of patients with mucosal-predominant pemphigus vulgaris. Intern Med J. 2015;45:284-292.
McMillan R, Taylor J, Shephard M, et al. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucocutaneous pemphigus vulgaris. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120:132-142.
Cirillo N, Cozzani E, Carrozzo M, Grando SA. Urban legends: pemphigus vulgaris. Oral Dis. 2012;18:442-558.
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 randomized trial. Lancet. 2017;389:20131-22040.
Fortuna G, Calabria E, Ruoppo E, et al. The use of rituximab as an adjuvant in the treatment of oral pemphigus vulgaris. J Oral Pathol Med. 2019. https://doi.org/10.1111/jop.12951
Laftah Z, Craythorne E, Mufti GJ, du Vivier A. Clinical efficacy of rituximab in the treatment of pemphigus vulgaris: A 10-year follow-up. J Oral Pathol Med. 2019;48:861-862.
Feliciani C, Cozzani E, Marzano AV, et al. Italian guidelines in pemphigus - adapted from the European Dermatology Forun (EDF) and European Academy of Dermatology and Venerology (EADV). Giornale Italiano di Dermatologia e Venereologia. 2018;153:599-608.