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July 2011

Rituximab for Severe Mucous Membrane Pemphigoid: Safe Enough to Be Drug of First Choice?

Author Affiliations

Author Affiliations: Departments of Dermatology, Philipps University, Marburg, Germany (Dr Hertl), University of Reims, France (Dr Bernard), and Inselspital-University of Bern, Switzerland (Dr Borradori).

Arch Dermatol. 2011;147(7):855-856. doi:10.1001/archdermatol.2011.167

In this issue of the Archives, Le Roux-Villet et al1 describe 25 patients with mucous membrane pemphigoid (MMP) who had either extensive disease for a mean of 32 months, ie, progressive eye and/or oral/tracheal involvement or were refractory to the initially applied immunosuppressive or immunomodulatory drugs. The cohort of patients with MMP had either ocular (n  =  10) and/or extraocular involvement (n  =  15) and received 1 or 2 cycles of rituximab (each cycle consisting of rituximab, 4   ×  375 mg/m2 administered intravenously at weekly intervals). After the first rituximab cycle, a total of 68% (17 of 25) of patients with MMP experienced complete clinical remission within 12 weeks, while an additional 5 of 25 patients required a second cycle of rituximab to achieve clinical remission. Overall, only 3 of 25 patients (12%) did not experience clinical remission with rituximab treatment. Most of the patients did not continue adjuvant immunosuppressive drugs and received only concomitant immunomodulatory treatment with dapsone or sulfasalazine during rituximab treatment. Of the 22 patients in complete remission, 10 developed a clinical relapse within 4 months, suggesting a short-lived effect of rituximab. Of note, 3 of 25 patients (12%) developed severe infections within 4 months after rituximab treatment and 2 patients died.

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