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Off-label use of rituximab in dermatology: pemphigus treatment.

Bomm L, Fracaroli TS, Sodré JL, Bressan A, Gripp AC - An Bras Dermatol (2013 Jul-Aug)

Bottom Line: Since its approval in 1997 by the FDA (United States Food and Drug Administration), rituximab has been used for certain B-cell lymphomas and treatment-resistant rheumatoid arthritis.Nevertheless, over the past 14 years, many case reports have demonstrated the efficacy of off-label rituximab in several dermatological inflammatory conditions.This study describes two cases of pemphigus vulgaris and two cases of pemphigus foliaceous that were treated with rituximab at 375 mg/m2 once a week for 4 weeks, and that responded well to treatment.

View Article: PubMed Central - PubMed

Affiliation: University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro(RJ), Brazil.

ABSTRACT
Since its approval in 1997 by the FDA (United States Food and Drug Administration), rituximab has been used for certain B-cell lymphomas and treatment-resistant rheumatoid arthritis. Nevertheless, over the past 14 years, many case reports have demonstrated the efficacy of off-label rituximab in several dermatological inflammatory conditions. This study describes two cases of pemphigus vulgaris and two cases of pemphigus foliaceous that were treated with rituximab at 375 mg/m2 once a week for 4 weeks, and that responded well to treatment.

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A. Patient with pemphigus vulgaris before the use of rituximab;B. Patient with pemphigus vulgaris after the use of rituximab
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f01: A. Patient with pemphigus vulgaris before the use of rituximab;B. Patient with pemphigus vulgaris after the use of rituximab

Mentions: We present four cases of pemphigus treated with rituximab, taking into regardrefractoriness to conventional treatments or clinical rapidly progressive cases. Table 1shows the clinical data of these patients, including the age, sex, adjuvant, and assessmentafter infusion, with adverse effects, response, monitoring, and maintenance therapy.Patient number 1 had pemphigus vulgaris with a rapid and progressive evolution, withextensive mucosal involvement that did not respond to systemic corticosteroids taken inhigh doses (pulses of methylprednisolone 30mg/kg and prednisone 1-2mg/kg) (Figure 1A). The use of rituximab brought aboutimprovement within 15 days and the patient remained in remission for two and a half years,when he presented new mucosal lesions, but they were less intense and easily controlledwith steroids (Figure 1B). The other patients remainwithout disease activity, with gradual reduction of maintenance medication (Azatioprine12mg/kg, in gradual reduction) except patient number 2 who is in complete remission withoutmedication. We observed that patients with pemphigus foliaceus had a slower response totherapy, which is also the case with other therapies, but we found no justification forthis in the literature.


Off-label use of rituximab in dermatology: pemphigus treatment.

Bomm L, Fracaroli TS, Sodré JL, Bressan A, Gripp AC - An Bras Dermatol (2013 Jul-Aug)

A. Patient with pemphigus vulgaris before the use of rituximab;B. Patient with pemphigus vulgaris after the use of rituximab
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3760958&req=5

f01: A. Patient with pemphigus vulgaris before the use of rituximab;B. Patient with pemphigus vulgaris after the use of rituximab
Mentions: We present four cases of pemphigus treated with rituximab, taking into regardrefractoriness to conventional treatments or clinical rapidly progressive cases. Table 1shows the clinical data of these patients, including the age, sex, adjuvant, and assessmentafter infusion, with adverse effects, response, monitoring, and maintenance therapy.Patient number 1 had pemphigus vulgaris with a rapid and progressive evolution, withextensive mucosal involvement that did not respond to systemic corticosteroids taken inhigh doses (pulses of methylprednisolone 30mg/kg and prednisone 1-2mg/kg) (Figure 1A). The use of rituximab brought aboutimprovement within 15 days and the patient remained in remission for two and a half years,when he presented new mucosal lesions, but they were less intense and easily controlledwith steroids (Figure 1B). The other patients remainwithout disease activity, with gradual reduction of maintenance medication (Azatioprine12mg/kg, in gradual reduction) except patient number 2 who is in complete remission withoutmedication. We observed that patients with pemphigus foliaceus had a slower response totherapy, which is also the case with other therapies, but we found no justification forthis in the literature.

Bottom Line: Since its approval in 1997 by the FDA (United States Food and Drug Administration), rituximab has been used for certain B-cell lymphomas and treatment-resistant rheumatoid arthritis.Nevertheless, over the past 14 years, many case reports have demonstrated the efficacy of off-label rituximab in several dermatological inflammatory conditions.This study describes two cases of pemphigus vulgaris and two cases of pemphigus foliaceous that were treated with rituximab at 375 mg/m2 once a week for 4 weeks, and that responded well to treatment.

View Article: PubMed Central - PubMed

Affiliation: University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro(RJ), Brazil.

ABSTRACT
Since its approval in 1997 by the FDA (United States Food and Drug Administration), rituximab has been used for certain B-cell lymphomas and treatment-resistant rheumatoid arthritis. Nevertheless, over the past 14 years, many case reports have demonstrated the efficacy of off-label rituximab in several dermatological inflammatory conditions. This study describes two cases of pemphigus vulgaris and two cases of pemphigus foliaceous that were treated with rituximab at 375 mg/m2 once a week for 4 weeks, and that responded well to treatment.

Show MeSH
Related in: MedlinePlus