First-line combination therapy with rituximab and corticosteroids provides a high complete remission rate in moderate-to-severe bullous pemphigoid
Journal
British Journal of Dermatology
Journal Volume
173
Journal Issue
1
Pages
302
Date Issued
2015-07
Author(s)
Abstract
Funding sources: none. Conflicts of interest: none declared. Dear Editor, Bullous pemphigoid (BP) is the most common autoimmune blistering disease, mainly affecting the elderly. Despite improvements in treatment modalities, the 1‐year mortality rate of patients with BP is still high, ranging from 13% to 38%.1 2 Recently, we reported the effectiveness of rituximab, a monoclonal anti‐CD20 antibody, as first‐line therapy for pemphigus.3 Therefore, we have attempted to measure the utility of rituximab as first‐line therapy for BP. From 2010 to 2012 we performed a retrospective case–control study in a referral centre in Taiwan, including patients with the generalized form of BP requiring systemic treatment. Diagnosis of BP was based on typical clinical presentations, characteristic histopathological findings, and the presence of autoantibodies on direct and/or indirect immunofluorescence studies. In the first‐line combination therapy group (group R), the regimen included four weekly infusions of 500 mg rituximab (MabThera™; Roche, Basel, Switzerland), and corticosteroids, with a starting dose of prednisolone of 0·5 mg kg−1 daily (Table 1). The dose of corticosteroids was tapered rapidly after disease was controlled. Each dose lasted for 3–4 weeks, with a total duration of 2 years. The other four experienced disease recurrence. Nevertheless, relapses in these cases were mild and easily controlled. The mean duration of CRoff in these four patients was 27 weeks (range 22–35 weeks). The risk of infection was slightly lower in group R than in group C (31% vs. 53%), but it was not statistically significant (P =0·22). Urinary tract infection and pneumonia were the leading infections in groups R and C, respectively. The 1‐year mortality rate of group R was much lower than that of group C (15% vs. 37%), but it was not significantly different (P =0·18).
SDGs
Other Subjects
autoantibody; prednisolone; rituximab; corticosteroid; dermatological agent; rituximab; adult; aged; bullous pemphigoid; case control study; clinical article; comorbidity; controlled study; disease severity; eosinophil count; female; follow up; human; immunofluorescence; infection risk; Letter; male; patient referral; pneumonia; priority journal; remission; retrospective study; systemic therapy; treatment duration; urinary tract infection; drug combination; middle aged; Pemphigoid, Bullous; remission; treatment outcome; very elderly; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Case-Control Studies; Dermatologic Agents; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pemphigoid, Bullous; Remission Induction; Retrospective Studies; Rituximab; Treatment Outcome
Publisher
Blackwell Publishing Ltd
Type
letter