Investigating the clinical efficacy of different doses of rituximab in patients with pemphigus

Pemphigus is a severe autoimmune skin disease traditionally treated with systemic corticosteroids and immunosuppressants. Recent studies have highlighted the superior efficacy of rituximab combined with systemic corticosteroids, establishing this combination as a first-line treatment for pemphigus patients.

Currently, the administration protocols for rituximab in pemphigus patients often refer to the dosage used for rheumatoid arthritis: two intravenous infusions of 500 mg or 1000 mg spaced two weeks apart, with an additional 500 mg infusion after 6 to 9 months if necessary. Recently, several studies have reported successful treatment of pemphigus using low-dose (single 500 mg dose) or ultra-low-dose (single 200 mg dose) rituximab.

As an optimal dosage regimen for pemphigus has yet to be established, we conducted a retrospective cohort study to evaluate the efficacy of different rituximab dosages and explore the optimal dosing strategy for the treatment of pemphigus.

Inclusion Criteria:

1. patients with a diagnosis of pemphigus vulgaris or foliaceus in active stage based on guideline indicators, including typical clinical presentation, positive direct immunofluorescence microscopy findings, and/or detection of serum anti-Dsg3 and/or Dsg1 immunoglobin (Ig)G autoantibodies
2. follow-up for at least 6 months after initiation of rituximab therapy

Exclusion Criteria:

1. Previous use of rituximab for other indications
2. concomitant use of other biological agents within 6 months (e.g. Dupilumab,IL-17,FcRn)
3. with a diagnosis of other variants of pemphigus besides PV and PF

Patients who had a clinical presentation of active pemphigus combined with immunological or pathological evidence, and received rituximab