Rituximab is Safe, Feasible for Improving Remission in Bullous Pemphigoid

Bullous pemphigoid
Bullous pemphigoid
Treatment with rituximab may improve remission rates, reduce the use of steroids, and be safe in patients with bullous pemphigoid.

Researchers found that treatment with rituximab was associated with high remission rates, high steroid-sparing activity, and acceptable safety in patients with severe or refractory bullous pemphigoid (BP), according to study findings published in the Journal of the American Academy of Dermatology.

Researchers from Emory University in Atlanta, Georgia, reviewed the medical charts of 20 patients with severe BP with widespread body-surface area involvement who had received ≥1 dose of rituximab. Treatment was administered at a dose of 1 gram repeated in 2 weeks or 375 mg/m2 weekly for 4 weeks. At each visit, the investigators recorded patients’ clinical status, Bullous Pemphigoid Disease Activity Index (BPDAI), demographics, treatment course, concurrent therapies, and clinical assessment data. Patients were divided into 3 subgroups: baseline, flare, or remission.

Approximately 35% and 15% of patients had an additional autoimmune disease and an underlying neurologic disease, respectively. The majority of patients received 1 course of rituximab (n=17), whereas 2 patients received 2 and 1 patient received 3. Median time to remission after rituximab initiation was 196 days (range, 131 to 418 days), and median time to post-treatment relapse was 508 days (range, 328 to 965 days). After an average of 169 days (range, 57 to 418 days) following rituximab, 75%  of patients (n=15) achieved durable remission, and 8 of these patients achieved partial remission. The incidence rate of adverse events before rituximab and after rituximab was 1.836 vs 0.827, respectively (P <.001).

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Study limitations included the small patient sample, the recruitment of patients from a single center, and the retrospective design.

Overall, the study’s findings “present rituximab as a therapeutic option for patients with BP along with monitoring of peripheral biomarkers to help guide therapy,” the researchers wrote.

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Polansky M, Eisenstadt R, DeGrazia T, et al. Rituximab therapy in patients with bullous pemphigoid: a retrospective study of 20 patients [published online March 25, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.03.049