A systematic review on efficacy, safety, and treatment-durability of low-dose rituximab for the treatment of Pemphigus : special focus on COVID-19 pandemic concerns

BACKGROUND: Rituximab is a FDA-approved monoclonal antibody for adults with moderate to severe potentially life-threatening pemphigus vulgaris. Recent studies have focused on assessments of efficacy and safety of low-dose rituximab (<2 gram in each cycle).

METHOD: Databases were searched from 2010 to 2020 (last update: 1 June 2020).

RESULT: Nine studies were entered; including180 cases (92: women, 88: men, age range: 9-83 years). The dosages of each Rituximab cycle varied between ultra-low-dose (≤500 mg for a cycle, either multiple infusions or a single infusion), low-dose (2 × 375 mg/m2 or 2 × 500 mg) and modified-dose (3 × 375 mg/m2 or 3 × 500 mg). The efficacy and safety of Rituximab in the studies are known by the recovery time, relapse time, and side events. According to the studies, 2 × 500 can lead to complete remission in a broad range, from 35 to 82%. These differences might be explained by different end-points and variable cumulative corticosteroid dosage after RTX administration. Although the studies showed that low dose RTX is efficient, there are some controversies regarding the choosing low-dose for severe patients.

CONCLUSION: Considering the effectiveness of low-dose, intermediate dose, and ultra-low-dose protocols of Rituximab in inducing remission in pemphigus disease and considering factors such as cost of therapy, and the need to induce a minimum of immunosuppression for a minimum duration in the COVID-19 pandemic, suggested to use low-dose Rituximab protocol (2 infusions of 500 mg Rituximab: interval of 2 weeks) to induce the remission in mild-to-moderate pemphigus patients.

Media Type:

Electronic Article

Year of Publication:

2021

Contained In:

Immunopharmacology and immunotoxicology - Vol. 43, No. 5 (2021), p. 507-518

Language:

English

Contributors:

Tavakolpour, Soheil
Aryanian, Zeinab
Seirafianpour, Farnoosh
Dodangeh, Milad
Etesami, Ifa
Daneshpazhooh, Maryam
Balighi, Kamran
Mahmoudi, Hamidreza
Goodarzi, Azadeh

Links:

Volltext

Keywords:

*Immunocompromised Host
4F4X42SYQ6
Adolescent
Adult
Aged
Aged, 80 and over
Autoimmune bullous skin disorder
COVID-19
Child
Female
Humans
Immunologic Factors
Journal Article
Low-dose
Male
Middle Aged
Pemphigus
Remission Induction
Risk Factors
Rituximab
SARS-CoV-2
Systematic Review
Systematic review
Treatment Outcome
Ultra-low-dose
Under-standard dose
Young Adult

Notes:

Date Completed 29.09.2021

Date Revised 29.09.2021

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1080/08923973.2021.1953063

PMID:

34287098

PPN (Catalogue-ID):

NLM329486225