Efficacy of Rituximab treatment for pemphigus: Results from a single-center study of 113 patients with a long-term follow-up

Background: Rituximab treatment combined with systemic corticosteroids (CS) has shown efficacy in pemphigus disease, however, real-life data regarding the efficacy and safety of Rituximab is still lacking.

Objective: To assess the characteristics and clinical response of patients with pemphigus receiving rituximab combined with systemic CS.

Methods: A retrospective cohort study was conducted using records from a tertiary referral center for autoimmune bullous disorders. Inclusion criteria included pemphigus patients who received their first rituximab treatment between January 1, 1995, and June 10, 2019.

Results: A total of 113 patients [pemphigus vulgaris, 96 patients (85%), pemphigus foliaceus, 17 (15%)] received 1 to 6 rituximab cycles combined with systemic CS. The median duration of follow-up was 53 months (range 2-300). After the initial cycle, 80 patients (70.8%) achieved remission. The median time to remission was 4 months (range 1-21). Of the 80 patients in remission, 27 (23%) remained in remission with or without systemic CS treatment at the last follow-up. There was a 41% relapse rate in a median time of 18 months (range 7-74m). Of these patients, 28 received a second rituximab cycle and three received a third rituximab cycle. 33 patients (29.2%) did not achieve remission after the first cycle. Overall, 97 patients (86%) achieved remission during their follow-up period. Infusion reactions were reported in 10 patients (8.8%). Serious infections adverse events occurred in 8 patients.

Conclusion: Rituximab therapy combined with systemic CS induced clinical remission in the majority of patients with pemphigus with a relatively good safety profile.