Rituximab in the adjuvant treatment of pemphigus vulgaris: a prospective open-label pilot study in five patients
Rituximab in the adjuvant treatment of pemphigus vulgaris: a prospective open-label pilot study in five patients
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DOI：
10.1111/j.1365-2133.2007.07800.x
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发表时间：
2007-05-01
影响因子：
10.3
通讯作者：
Prince, H. M.
中科院分区：
文献类型：
--
作者：
Goh, M. S. Y.;McCormack, C.;Prince, H. M.
利妥昔单抗是一种靶向表达于B淋巴细胞的CD20抗原的单克隆抗体。有报道称其治疗自身免疫性疾病，包括天疱疮的疗效。目的前瞻性评价利妥昔单抗辅助治疗寻常型天疱疮（PV）的疗效。方法：在这项前瞻性开放标签先导研究中，PV患者每周静脉注射利妥昔单抗（375 mg m(-2)），持续4周。其他并发免疫抑制继续进行。结果5例患者中，1例获得完全缓解，能够停止所有药物治疗，2例获得临床病变清除，但继续进行全身治疗。2例患者病情进展。反应时间为2-8个月，反应持续时间为13- 18个月。反应与血清抗上皮抗体的减少有关。2例患者有明显的感染性并发症（1例发展为社区获得性肺炎伴迟发性中性粒细胞减少症，另1例发展为巨细胞病毒感染）。结论利妥昔单抗治疗PV有较好的疗效。使用多种免疫抑制剂的患者应密切监测感染并发症。
Background Rituximab is a monoclonal antibody directed against the CD20 antigen expressed on B lymphocytes. There are reports of its efficacy in the treatment of autoimmune diseases, including pemphigus.Objectives Prospectively to evaluate the efficacy of rituximab as adjuvant treatment for pemphigus vulgaris (PV).Methods Patients with PV were treated with intravenous rituximab (375 mg m(-2)) weekly for 4 weeks in this prospective open-label pilot study. Other concurrent immunosuppression was continued.Results Of five patients, one achieved complete remission and was able to cease all medication, while two achieved clearance of clinical lesions but continued on systemic therapy. Two patients had progressive disease. Time to response was 2-8 months, with a 13- to 18-month response duration. Response was associated with reduction in serum antiepithelial antibodies. Two patients had significant infectious complications (one developed community-acquired pneumonia associated with delayed-onset neutropenia and the other developed cytomegalovirus infection).Conclusions Rituximab has shown efficacy in the treatment of PV. Patients on multiple immunosuppressives should be closely monitored for infectious complications.