Long-Term Remissions in Recalcitrant Pemphigus Vulgaris

• Published in: The New England journal of medicine Vol. 373; no. 27; pp. 2693 - 2694
• Main Authors: Ahmed, A. Razzaque, Kaveri, Srini, Spigelman, Zachary
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 31.12.2015
• Subjects: B-Lymphocytes; Follow-Up Studies; Globulins; Humans; Immunoglobulin G - analysis; Immunoglobulins; Immunoglobulins, Intravenous - therapeutic use; Immunologic Factors - therapeutic use; Intravenous administration; Lymphocyte Count; Monoclonal antibodies; Pemphigus; Pemphigus - drug therapy; Pemphigus - immunology; Remission; Remission Induction; Rituximab; Rituximab - therapeutic use
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMc1508234

In a case series involving 10 patients with recalcitrant recurrent pemphigus vulgaris, a combination of rituximab plus intravenous immune globulin induced complete remission for 10 years or more, with no further therapy. To the Editor: Pemphigus vulgaris is a potentially fatal autoimmune blistering disease that affects the skin and mucous membranes. 1 Dramatic improvement has been observed with the use of rituximab and the protocols for lymphoma or rheumatoid arthritis. In these studies, patients with either condition were simultaneously treated with systemic glucocorticoids and immunosuppressive agents. 2 A significant majority of these patients undergo clinical remission within a few weeks. 2 However, cumulative data from case reports and case series show that relapse occurs in 50 to 80% of patients. 3 The prolonged period of immunosuppression from rituximab and concomitant therapy can produce several side effects, . . .