ABSTRACT

Introduction: This review assesses current evidence supporting dose de-escalated rituximab therapy in pemphigus vulgaris, compared to standard protocols. Primary outcome measures were remission and relapse rates. Adverse effects, cumulative steroid dosages, and serological markers of disease activity were also reported.

Areas covered: A literature search was performed to look for reports describing the use of de-escalated rituximab therapy in pemphigus vulgaris. Results from heterogenous studies showed a large variation in remission and relapse rates. Complete remission rates from de-escalated treatment ranged from 41.7 to 100.0%, while rates in the control groups ranged from 60.0 to 90.9%. Relapse rates varied from 8.0 to 81.3% in the de-escalated group and from 0.0 to 72.4% in the control group. Of the 165 patients included in this report, only two major adverse effects were reported.

Expert Opinion: Overall, dose de-escalated rituximab protocols reported to date appear effective and safe. However, it is unclear if treatment effect parallels that of standard regimens in regard to disease control in the long term. A lower limit of effective dosing for rituximab in pemphigus vulgaris has not yet been reached or defined. The role for and timing of repeated cycles of low-dose rituximab therapy require further exploration.

摘要

简介：本综述评估了与标准方案相比支持利妥昔单抗剂量递减治疗寻常型天疱疮的当前证据。主要结果指标是缓解率和复发率。还报告了不良反应、累积类固醇剂量和疾病活动的血清学标志物。

涵盖领域：进行文献检索以查找描述使用降级利妥昔单抗治疗寻常型天疱疮的报告。异质性研究的结果显示缓解率和复发率存在很大差异。降级治疗的完全缓解率为 41.7% 至 100.0%，而对照组的完全缓解率为 60.0% 至 90.9%。降阶梯组的复发率从 8.0% 到 81.3% 不等，而对照组的复发率从 0.0% 到 72.4% 不等。在本报告纳入的 165 名患者中，仅报告了两种主要不良反应。

专家意见：总体而言，迄今为止报告的剂量递减的利妥昔单抗方案似乎有效且安全。然而，从长远来看，尚不清楚治疗效果是否与标准治疗方案在疾病控制方面的效果相当。利妥昔单抗治疗寻常型天疱疮的有效剂量下限尚未达到或确定。低剂量利妥昔单抗治疗重复周期的作用和时机需要进一步探索。