Adjuvant rituximab therapy of pemphigus: a single-center experience with 31 patients.
Adjuvant rituximab therapy of pemphigus: a single-center experience with 31 patients.
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DOI：
10.1001/archdermatol.2012.1522
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发表时间：
2012-09
影响因子：
--
通讯作者：
Payne AS
中科院分区：
文献类型：
--
作者：
Lunardon L;Tsai KJ;Propert KJ;Fett N;Stanley JR;Werth VP;Tsai DE;Payne AS
我们进行了一项回顾性研究，寻常型天疱疮（n=24）和落叶型天疱疮（n=7）患者辅助利妥昔单抗治疗，以确定疗效和不良事件。疗效终点是在无治疗或最小治疗的情况下疾病完全缓解。18例患者（58%）达到研究终点。其中，13例患者在全身治疗后完全缓解。达到研究终点的患者在利妥昔单抗治疗前的中位病程为19个月，而未达到终点的患者为86个月（p=0.01）。对于达到终点的18例患者，中位缓解持续时间为19 +/-2个月。这18例患者中有8例（44%）在治疗后6-17个月复发。2名患者（6%）发生了利妥昔单抗引起的严重不良事件（骨髓炎、蜂窝织炎）。在利妥昔单抗治疗前后10例患者的配对血清样本中，血清桥粒芯蛋白指数值的百分比变化（中位数为-80%）与肺炎球菌抗体的百分比变化（中位数为+8%）无关（斯皮尔曼等级相关系数r=-0.2）。我们的经验表明，患者在病程早期接受利妥昔单抗治疗可能会有更好的结果。对利妥昔单抗作用机制的讨论支持了早期治疗的基本原理。需要前瞻性临床研究来证实这一观察结果。
We conducted a retrospective study of pemphigus vulgaris (n=24) and foliaceus (n=7) patients treated with adjuvant rituximab to determine efficacy and adverse events. The endpoint for efficacy was complete remission of disease on no or minimal therapy. 18 patients (58%) achieved the study endpoint. Of these, 13 patients achieved complete remission off systemic therapy. Patients achieving the study endpoint had a median disease duration prior to rituximab of 19 months, versus 86 months in those not achieving the endpoint (p=0.01). For the 18 patients achieving the endpoint, the median duration of remission was 19 +/− 2 months. Eight (44%) of these 18 patients relapsed 6–17 months after treatment. Serious adverse events attributed to rituximab (osteomyelitis, phlegmon) occurred in two patients (6%). In paired serum samples from 10 patients before and after rituximab, the percent change in serum desmoglein index value (median −80%) was unrelated to the percent change in pneumococcal antibodies (median +8%) (Spearman rank correlation coefficient r=−0.2). Our experience suggests that patients treated with rituximab earlier in the course of disease may have better outcomes. A discussion of rituximab mechanism of action supports the rationale for early therapy. Prospective clinical studies are necessary to substantiate this observation.
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