Knowledge, Attitude, and Practice of Use of Rituximab in Pemphigus among Indian Dermatologists: A Cross-Sectional Questionnaire-Based Survey.

Abstract

Background: Rituximab has changed the paradigm for management of pemphigus vulgaris (PV). Despite its widespread use, variability exists in its use, particularly related to dosing protocols, prophylaxis, and use in special populations. This study aimed to assess dermatologists' knowledge, attitude, and practices regarding rituximab in India.

Materials and methods: A cross-sectional questionnaire-based survey was conducted among Indian dermatologists with at least six months of clinical experience post-residency between March and June 2024. An 85-question survey was used to gather information on knowledge, attitudes, and practices related to rituximab. Descriptive statistics were employed to analyze the data and identify practice variations.

Results: Fifty-five dermatologists with a mean practice experience of 13 years participated. Most (78.2%) preferred rituximab as first-line adjuvant for PV, citing higher remission rates and fewer long-term adverse effects. Knowledge of rituximab's mechanism of action was excellent. However, significant practice variability was observed. The standard dose rheumatoid arthritis protocol for moderate-to-severe disease was preferred by 69.1%, whereas only 14.5% strongly supported low-dose regimens. Screening for latent tuberculosis was commonly performed (80%). Prophylaxis for Pneumocystis jirovecii pneumonia and vaccination practices were inconsistent, with only 12.7% always prescribing prophylaxis. Additionally, 61.8% used rituximab retreatment on clinical relapse, with less emphasis on immunological markers for monitoring.

Limitations: The responses may not be representative of all dermatologists, especially those with less experience with rituximab.

Conclusion: While dermatologists demonstrated strong knowledge of rituximab, significant variability in dosing, prophylaxis, and retreatment practices exists. Standardized guidelines and educational initiatives may be needed to ensure consistent use of rituximab and improve patient outcomes.