Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.
Department of Dermatology, Tufts University School of Medicine, and the Center for Blistering Diseases, USA.
Expert Opin Biol Ther. 2021 Apr;21(4):443-454. doi: 10.1080/14712598.2021.1874915. Epub 2021 Mar 8.
Pemphigus vulgaris (PV) is a life-threatening autoimmune mucocutaneous blistering disease. Systemic corticosteroids (CS), while life-saving, have several serious side effects. To improve treatment and prognosis, recently rituximab (RTX), a chimeric monoclonal antibody against CD20 molecule on B cells, has become popular. This Expert Opinion discusses clinical and scientifically relevant aspects of RTX treating PV.
This presentation describes the mechanism of action, clinical efficacy, safety, adverse events, protocols used, and clinical outcomes. Concerns for infection, reactivation of latent or previous infections, and high relapse rate are discussed.
Use of RTX in PV is still a work in progress. There are many unanswered questions. FDA did not provide a protocol or guidelines. Whenever RTX is used, systemic corticosteroids are simultaneously used, albeit for a shorter duration and lower dose. Used in these doses for these durations they can cause immunosuppression. Would it be more appropriate if instead of 'First Line Therapy' it would be more advisable to use the term 'First Adjunctive Immunosuppressive Agent'?
寻常型天疱疮（PV）是一种危及生命的自身免疫性黏膜皮肤水疱病。全身性皮质类固醇（CS）虽然有救命作用，但有几个严重的副作用。为了改善治疗和预后，最近利妥昔单抗（RTX），一种针对 B 细胞 CD20 分子的嵌合单克隆抗体，已变得流行。本专家意见讨论了 RTX 治疗 PV 的临床和科学相关方面。
本演讲描述了 RTX 的作用机制、临床疗效、安全性、不良事件、使用的方案和临床结果。讨论了感染、潜伏或先前感染的再激活以及高复发率的问题。
RTX 在 PV 中的使用仍在进行中。还有许多未解决的问题。FDA 没有提供方案或指南。只要使用 RTX，就会同时使用全身性皮质类固醇，尽管使用时间更短，剂量更低。以这些剂量和时间使用它们会引起免疫抑制。如果用“辅助免疫抑制剂”代替“一线治疗”，是否更合适？
