Evaluation of rituximab infusion therapy in patients with recalcitrant pemphigus vulgaris

The usual approach is to treat pemphigus vulgaris by corticosteroids and in some cases, immune suppressive agents may be indicated. The response is often satisfactory to the patient and acceptable clinically; however, the use of such agents is not free of side effects. Adverse effects associating the use of corticosteroids and immune-suppressing agents are numerous, but the principal side effects are those of fatal infections and neoplastic disorders. Therefore, the search for other forms of treatment modalities has been proven necessary, especially in resistant and recalcitrant types of the disorder. A number of studies have shown role Rituximab in the treatment of pemphigus vulgaris; however, results were conflicting. Therefore we planned and conducted the current study to assess the efficacy of this drug in the treatment of recalcitrant cases of pemphigus vulgaris in a sample of Iraqi patients in the Mid-Euphrates region. to assess the efficacy of Rituximab in the treatment of recalcitrant cases of pemphigus vulgaris in a sample of Iraqi patients in the Mid-Euphrates region. The current cohort study included 10 patients with pemphigus vulgaris. Those patients were selected from the pool of patients visiting the dermatology consultation unit at Al-Diwaniyah teaching hospital, Al-Diwaniyah Province, Iraq during the period from January 2017 through June 2019. Age, gender, duration of disease, previous treatment, and maintenance treatment were the main variables included in the study; the outcome was a response to treatment classified as satisfactory, partially satisfactory and unsatisfactory. All patients were given an intravenous infusion of Rituximab in a dose of a 375 mg/m2 in a weekly basis. The patients were followed for a minimum of 6 months. All patients were treated by intravenous rituximab and followed for a period of 6 up to 18 months, mean of 11.30 ±3.83 months. Four (40.0 %) patients developed a satisfactory response, 5 (50.0 %) had partial satisfaction, and a single patient had an unsatisfactory response. Response to treatment was no significantly correlated to patients' age, gender or duration of disease; however, there was a significant positive correlation between duration of treatment and response to it. Good rate of satisfaction can be obtained following the use of weekly based intravenous retuximab in patients with recalcitrant pemphigus vulgaris.