Comparative Study Between Two Protocols of Rituximab in Pemphigus: About 63 Cases

Abstract

Background: Pemphigus is a rare autoimmune mucocutaneous bullous disease. It includes pemphigus vulgaris and pemphigus superficial. Rituximab is an antibody that targets CD-20 molecules on B-cells and has been approved as a first-line treatment for moderate to severe pemphigus vulgaris. The aim of our study is to evaluate the efficacy and safety of Rituximab in the treatment of pemphigus patients. Materials and methods: It is a prospective study extending over a period of 6 years from December 2016 to July 2022, including all patients with severe or treatment-resistant pemphigus who received treatment with RITUXIMAB at a dose of 375 mg/m2/week for 4 weeks (lymphoma protocol) or 2 infusions of 1 g at 15-day intervals (rheumatoid arthritis protocol (PR protocol)), combined with oral corticosteroid therapy at a dose of 0.5 to 1 mg/kg/day (depending on severity) with a 6-month taper. Maintenance treatment depends on the IFI level. In the case of high levels, an infusion of 1 g after 6 months is given and in the case of low levels, an infusion of 500 mg after 1 year is given. Consent and authorization from the local ethics committee were required. The datan were entered into an Excel program and analyzed via Epi info version 7 software. Patients receiving CNSS health insurance were excluded. Results: 63 patients with pemphigus were using Rituximab (PR protocol: 44 lymphoma protocol: 19), 3 of which are currently being followed up (< 6 months). 44 cases of pemphigus vulgaris of which 15 received the lymphoma protocol and 29 received the PR protocol, 14 cases of superficial pemphigus of which 4 cases received the lymphoma protocol, and 10 cases of PR protocol and 5 cases of vegetative pemphigus received the PR protocol.