Rituximab: A Magic Bullet for Pemphigus
Introduction: Pemphigus, an autoimmune disease, was fatal before the era of corticosteroids. With the advent of steroids, mortality decreased but morbidity was present due to the side effects of high dose steroids. Newer drugs targeted at the molecular level are said to have fewer side effects a...
Main Authors: | , , , , |
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Format: | Article |
Language: | English |
Published: |
JCDR Research and Publications Private Limited
2017-04-01
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Series: | Journal of Clinical and Diagnostic Research |
Subjects: | |
Online Access: | https://jcdr.net/articles/PDF/9717/21868_CE(RA1)_F(T)_PF1(RB_PY)_PFA(RB_SS).pdf |
Summary: | Introduction: Pemphigus, an autoimmune disease, was fatal
before the era of corticosteroids. With the advent of steroids,
mortality decreased but morbidity was present due to the side
effects of high dose steroids. Newer drugs targeted at the
molecular level are said to have fewer side effects and improved
effectiveness.
Aim: The aim of our study was to assess the effectiveness of
one such drug, Rituximab, a biological, in treating pemphigus
vulgaris and to identify common adverse events.
Materials and Methods: It was an open label prospective
interventional study, conducted from September 2013 to May
2015, in the Department of Dermatology, Stanley Medical College,
Chennai, Tamil Nadu, India. Twenty patients with pemphigus were
included in the study. Ten were refractory to conventional therapy
and 10, new cases. Patients who satisfied inclusion and exclusion
criteria were included in the study after informed, written consent.
Rituximab was administered according to Rheumatoid arthritis
protocol. The patients were followed up as out patients after
discharge, end points and adverse events were noted.
Results: There were 14 females (70%) and six males (30%).
The mean age of the study group was 41.35 years. The mean
disease duration was 11.7 months. The mean duration of follow
up being 14.25 months. After rituximab, 13 patients remained in
remission for varying periods of 3-22 months. The mean duration
of complete remission off- treatment with Dexamethasone
Cyclophosphamide Pulse (DCP) was 3.6 months; with rituximab
it was 8.8 months. Seven (35%) patients relapsed during the
study of whom six had received rituximab after being refractory
to conventional treatment. Patients who relapsed had higher
mean disease duration (21 months) than the remission group
(6.384 months). Two patients (10%) developed immediate
adverse events. Six patients (30%) developed late adverse
events the commonest being reactivation of herpes labialis.
Conclusion: Rituximab was effective in treating pemphigus
vulgaris, was significantly better than conventional treatment,
decreased the need for additional steroids and other
immunosuppressants and induced prolonged remission.
Rituximab was more effective when given early in the disease
process. Further studies may highlight the need for additional
cycles of rituximab to maintain sustained remission. |
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ISSN: | 2249-782X 0973-709X |