Treatment of refractory pemphigus vulgaris with anti-CD20 monoclonal antibody (rituximab): Five cases

Background: Pemphigus vulgaris is an autoimmune disease characterized by blisters and widespread erosions, involving skin and mucous membranes, caused by autoantibodies to desmoglein 1 and 3. This pathology is associated with increased morbidity and mortality if untreated. The treatment of pemphigus vulgaris requires multiple immunosuppressive agents, but often it is particularly resistant. Objective: To evaluate the efficacy and safety of rituximab therapy in refractory pemphigus vulgaris. Methods: Five patients diagnosed as having pemphigus vulgaris were treated with anti-CD20 monoclonal antibody ( rituximab). Each patient was treated with rituximab intravenously at a dosage of 375 mg per square metre of body surface area once weekly for 4 weeks. Results: All the patients presented clinical resolution. No adverse effects were observed. It is important to observe the clinical evolution in the future, but our experience is still limited to a short lifetime and follow-up. Conclusion: In our experience rituximab has been an effective and safe treatment for refractory pemphigus vulgaris.