Few case series have shown efficacy of rituximab in resistant cases of pemphigus. There are individual case reports of use of rituximab in childhood pemphigus.
ORIGINAL ARTICLE
Efficacy and safety of rituximab treatment in Indian pemphigus patients
Article first published online: 17 DEC 2011
DOI: 10.1111/j.1468-3083.2011.04391.x
© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology
Issue

Journal of the European Academy of Dermatology and Venereology
Volume 27, Issue 1, pages e17–e23, January 2013
Additional Information
How to Cite
Kanwar, A.J., Tsuruta, D., Vinay, K., Koga, H., Ishii, N., Dainichi, T. and Hashimoto, T. (2013), Efficacy and safety of rituximab treatment in Indian pemphigus patients. Journal of the European Academy of Dermatology and Venereology, 27: e17–e23. doi: 10.1111/j.1468-3083.2011.04391.x
We have shown the efficacy of rituximab in the Indian pemphigus patients, for the first time. Clinical response showed good correlation with fall in anti-Dsg1 antibody indices, whereas there was only a partial reduction in anti-Dsg3 indices. Childhood pemphigus also responded to rituximab therapy.
Funding source This study was supported by Grants-in-Aid for Scientific Research and Strategic Research Basis Formation Supporting Project from the Ministry of Education, Culture, Sports, Science and Technology of Japan, and by Health and Labour Sciences Research Grants and grants for Research on Measures for Intractable Diseases from the Ministry of Health, Labour and Welfare of Japan. The study was also supported by grants from the Uehara Memorial Foundation, Nakatomi Foundation, Kaibara Morikazu Medical Science Promotion Foundation, Japan Lydia O’Leary Memorial Foundation, Cosmetology Research Foundation, Japanese Dermatological Association (Shiseido Award), Fukuoka Foundation for Sound Health, and Galderma K.K. (Galderma Award).
Conflict of interest None.
Publication History
- Issue published online: 18 DEC 2012
- Article first published online: 17 DEC 2011
- Received: 31 August 2011; Accepted: 21 November 2011
References
- 1, . Dexamethasone-cyclophosphamide pulse therapy in pemphigus. Int J Dermatol 1990; 29: 371–374.
- 2, . Pemphigus in India. Indian J Dermatol Venereol Leprol 2011; 77: 439–449.
- 3, . The adjuvant therapy of pemphigus. An update. Arch Dermatol 1996; 132: 203–212.
- 4, , . Rituximab in treatment-resistant autoimmune blistering skin disorders. Clin Rev Allergy Immunol 2008; 34: 56–64.
- 5, , . Rituximab in severe pemphigus. Ann N Y Acad Sci 2009; 1173: 683–691.
- 6, , et al. Successful treatment of paraneoplastic pemphigus in follicular NHL with rituximab: report of a case and review of treatment for paraneoplastic pemphigus in NHL and CLL. Am J Hematol 2001; 66: 142–144.
- 7, , . Anti-CD20 chimeric monoclonal antibody (rituximab) for the treatment of recalcitrant, life-threatening pemphigus vulgaris with implications in the pathogenesis of the disorder. J Am Acad Dermatol 2002; 47: 785–788.
- 8, , , . Rapid response of treatment-resistant pemphigus foliaceus to the anti-CD20 antibody rituximab. Br J Dermatol 2003; 149: 899–901.
- 9, , et al. Depletion of B cells in vivo by a chimeric mouse human monoclonal antibody to CD20. Blood 1994; 83: 435–445.
- 10, , et al. Chimeric anti-CD20 (IDEC-C2B8) monoclonal antibody sensitizes a B cell lymphoma cell line to cell killing by cytotoxic drugs. Cancer Biother Radiopharm 1997; 12: 177–186.
- 11
- 12, , et al. Rituximab for treatment-refractory pemphigus and pemphigoid: a case series of 17 patients. J Am Acad Dermatol 2011; 65: 552–558.
- 13, , et al. Treatment of severe pemphigus with a combination of immunoadsorption, rituximab, pulsed dexamethasone, and azathioprine/mycophenolate mofetil: a pilot study of 23 patients. Br J Dermatol 2011; Forthcoming Sep12. doi: 10.1111/j.1365-2133.2011.10585.x.
- 14, , , . Treatment of pemphigus vulgaris with rituximab and intravenous immune globulin. N Engl J Med 2006; 355: 1772–1779.
- 15, , et al. Treatment of severe pemphigus with rituximab: report of 12 cases and a review of the literature. Arch Dermatol 2007; 143: 1033–1038.
- 16, , et al. A single cycle of rituximab for the treatment of severe pemphigus. N Engl J Med 2007; 357: 545–552.
- 17, , et al. Consensus statement on definitions of disease, end points, and therapeutic response for pemphigus. J Am Acad Dermatol 2008; 58: 1043–1046.
- 18, , et al. History of the establishment and revision of diagnostic criteria, severity index and therapeutic guidelines for pemphigus in Japan. Arch Dermatol Res 2003; 295(Suppl. 1): S12–S16.
- 19, , et al. Characterization of autoantibodies in pemphigus using antigen-specific enzyme-linked immunosorbent assays with baculovirus-expressed recombinant desmogleins. J Immunol 1997; 159: 2010–2017.
- 20, , . Pemphigus in North India. J Cutan Med Surg 2006; 10: 21–25.
- 21, , et al. Recommendations for the use of rituximab (anti-CD20 antibody) in the treatment of autoimmune bullous skin diseases. J Dtsch Dermatol Ges 2008; 6: 366–373.
- 22, , . Long-term efficacy of dexamethasone-cyclophosphamide pulse therapy in pemphigus. Dermatology 2002; 204: 228–231.
- 23, , et al. Rituximab in the adjuvant treatment of pemphigus vulgaris: a prospective open-label pilot study in five patients. Br J Dermatol 2007; 156: 990–996.
- 24, , et al. ELISA testing of anti-desmoglein 1 and 3 antibodies in the management of pemphigus. Arch Dermatol 2009; 145: 529–535.
- 25, , , . Adjuvant drugs in autoimmune bullous diseases, efficacy versus safety: facts and controversies. Clin Dermatol 2010; 28: 337–343.
- 26
- 27, , , . Successful treatment of refractory childhood pemphgus vulgaris with anti-CD20 monoclonal antibody (rituximab). Pediatr Dermatol 2005; 22: 461–464.
- 28, , . Further experience with pemphigus in children. Pediatr Dermatol 1994; 11: 107–111.
- 29, . Pemphigus in pregnancy: fetal risk. Int J Gynaecol Obstet 1993; 42: 176–177.

1468-3083/asset/JDV_left.gif?v=1&s=1f5077e9ad670d0243350067014f92a67f0587c2)