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Early relapsing pemphigus patients may require maintenance dose after rituximab therapy

28 Jun 2018

Pemphigus patients with high baseline antidesmoglein 1 (anti-DSG1) indices relapse earlier, highlighting the importance of following them closely for the initial 12 months after rituximab therapy, suggests a recent study, adding that a maintenance rituximab dose during the first 12 months after initial therapy may be needed.

There were five early relapsing (before 12 months) patients, with a time to relapse of 6–11 months. Late relapsing (after 24 months) patients (n=6) had a time to relapse of 24–26 months.

There was a significant difference in the mean baseline anti-DSG1 index between early relapsing and late relapsing patients (705.72 vs 210.4, respectively; p=0.0014). In addition, there was a significant negative correlation between the baseline anti-DSG1 index and time to relapse (r, –0.777; p=0.00009).

“Because patients with high baseline anti-DSG1 indices relapsed earlier, it may be important to follow these patients closely for the initial 12 months after [rituximab] therapy,” the authors said. “These patients may require a maintenance [rituximab] dose during the first 12 months after [initial] therapy.”

A total of 19 patients (14 with pemphigus vulgaris and five with pemphigus foliaceus) were enrolled in this prospective study, which sought to compare early relapsing vs late relapsing patients following rituximab therapy.

The authors measured the baseline disease score, autoantibody levels and percentage of CD20+ cells of patients with pemphigus. One cycle of rituximab was given to the participants; they were followed for 26 months.

The study was limited by the small number of patients with pemphigus foliaceus.

“Rituximab is an effective therapy for patients with pemphigus; however, the therapy does not prevent relapse,” the authors said.

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