Mechanisms of Resistance to Rituximab Used for the Treatment of Autoimmune Blistering Diseases

• Published in: Life (Basel, Switzerland) Vol. 14; no. 10; p. 1223
• Main Authors: Popa, Liliana Gabriela, Dumitras, Ioana, Giurcaneanu, Calin, Berghi, Ovidiu, Radaschin, Diana Sabina, Vivisenco, Cristina Iolanda, Popescu, Marius Nicolae, Beiu, Cristina
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.10.2024; MDPI
• Subjects: Antibodies; Antigens; Autoantibodies; autoimmune blistering diseases; Autoimmune diseases; Blistering; Cells; Collagen; Cytotoxicity; Disease; Disease resistance; Drug resistance; Drug therapy; Health services; Immunoglobulins; Immunosuppressive agents; Lymphocytes; mechanism of action; Medical research; Medicine, Experimental; Monoclonal antibodies; Morbidity; Mortality; Pemphigus; Quality of life; Remission; Remission (Medicine); resistance; Review; Rituximab; Skin diseases; Skin resistance; Steroids; Romania; mechanism of action; pemphigus; autoimmune blistering diseases; resistance; rituximab
• ISSN: 2075-1729; 2075-1729
• DOI: 10.3390/life14101223

Autoimmune blistering diseases represent a group of chronic severe, disabling, and potentially fatal disorders of the skin and/or mucous membranes, primarily mediated by pathogenic auto-antibodies. Despite their rarity, these diseases are associated with significant morbidity and mortality and profound negative impact on the patient’s quality of life and impose a considerable economic burden. Rituximab, an anti-CD-20 monoclonal antibody, represents the first line of therapy for pemphigus, regardless of severity and a valuable off-label therapeutic alternative for subepidermal autoimmune blistering diseases as it ensures high rates of rapid, long-lasting complete remission. Nevertheless, disease recurrence is the rule, all patients requiring maintenance therapy with rituximab eventually. While innate resistance to rituximab in pemphigus patients is exceptional, acquired resistance is frequent and may develop even in patients with initial complete response to rituximab, representing a real challenge for physicians. We discuss the various resistance mechanisms and their complex interplay, as well as the numerous therapeutic alternatives that may be used to circumvent rituximab resistance. As no therapeutic measure is universally efficient, individualization of rituximab treatment regimen and tailored adjuvant therapies in refractory autoimmune blistering diseases are mandatory.