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利妥昔单抗对难治性寻常型天疱疮患者的长期治疗。

Prolonged treatment with rituximab in patients with refractory pemphigus vulgaris.

作者信息

Barrera Maria Victoria, Mendiola Maria Victoria, Bosch Ricardo Juan, Herrera Enrique

机构信息

Department of Dermatology, University Hospital, School of Medicine, Málaga, Spain.

出版信息

J Dermatolog Treat. 2007;18(5):312-4. doi: 10.1080/09546630701323988.

Abstract

OBJECTIVES

Recent reports have documented swift responses in refractory pemphigus vulgaris to rituximab, a monoclonal anti-CD20 antibody. Nevertheless, no standard protocol has yet been established for the administration of rituximab in patients with pemphigus vulgaris. We report the results of prolonged treatment with rituximab therapy in two patients with refractory pemphigus vulgaris.

METHODS

A 22- and a 27-year-old man were diagnosed with pemphigus vulgaris according to clinical, histopathological and immunofluorescence criteria. They failed to respond after several years of steroid and immunosuppressive treatment and experienced adverse effects. Rituximab was administered intravenously at a dose of 375 mg/m2 once weekly for 4 weeks.

RESULTS

Single infusions of rituximab 375 mg/m2 were repeated at 2-monthly intervals four times because of a delayed response. The treatment was well tolerated, no side effects were observed and the previous corticosteroid therapy could be progressively withdrawn.

CONCLUSIONS

The good response of our patients suggests that rituximab may be a valuable treatment option for refractory pemphigus vulgaris. It is important that clinicians are aware that the response to rituximab in pemphigus may be delayed, and that prolonged treatment may have a good outcome.

摘要

目的

近期报告记录了难治性寻常型天疱疮对利妥昔单抗(一种抗CD20单克隆抗体)的快速反应。然而,对于寻常型天疱疮患者使用利妥昔单抗的给药方式尚未建立标准方案。我们报告了两名难治性寻常型天疱疮患者接受利妥昔单抗长期治疗的结果。

方法

根据临床、组织病理学和免疫荧光标准,两名分别为22岁和27岁的男性被诊断为寻常型天疱疮。他们在接受数年的类固醇和免疫抑制治疗后均无反应且出现了不良反应。利妥昔单抗以375 mg/m²的剂量静脉注射,每周一次,共4周。

结果

由于反应延迟,每2个月重复单次输注375 mg/m²的利妥昔单抗,共进行了4次。治疗耐受性良好,未观察到副作用,先前的皮质类固醇治疗可逐渐停用。

结论

我们患者的良好反应表明,利妥昔单抗可能是难治性寻常型天疱疮的一种有价值的治疗选择。临床医生应意识到天疱疮患者对利妥昔单抗的反应可能会延迟,且延长治疗可能会有良好的结果,这一点很重要。

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