Complete remission after rituximab therapy of pemphigus

Although rituximab is clinically approved for pemphigus, real-world data on predictors of treatment success and optimal dosing remain limited. We conducted a retrospective cohort study of patients with pemphigus treated with rituximab with ≥1 year of follow-up at NewYork-Presbyterian Hospital. Patients initially received two 1000 mg doses 2 weeks apart or 4 weekly weight-adjusted (375 mg/m2) infusions. Factors associated with complete remission (CR) off oral immunosuppressive therapy were analyzed using Kaplan-Meier and Cox proportional hazards analyses. Among 105 patients, 44.7% achieved CR off therapy after the first rituximab cycle, increasing to 74.3% after multiple cycles, with a median time to remission of 7.4 months. Weight-adjusted rituximab dosing was associated with a higher likelihood of achieving CR off oral immunosuppressive therapy after the first rituximab cycle than the fixed-dose regimen (hazard ratio = 2.49, P = .01). For subsequent treatment, maintenance rituximab infusions every 6 months were associated with a shorter time to initial achievement of CR off therapy and a longer time to relapse than an on-demand approach; however, both achieved similar overall rates of CR off therapy. These findings support the benefit of weight-adjusted dosing for the first rituximab cycle and provide real-world data on outcomes of maintenance versus on-demand rituximab infusions for pemphigus therapy.

Abstract from PubMed