Publication: Rituximab therapy for treatment of pemphigus in Southeast Asians
Issued Date
2021-01-01
Resource Type
ISSN
11778881
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2-s2.0-85105024589
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Mahidol University
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SCOPUS
Bibliographic Citation
Drug Design, Development and Therapy. Vol.15, (2021), 1677-1690
Suggested Citation
Silada Kanokrungsee, Tanaporn Anuntrangsee, Jutamas Tankunakorn, Ploychompoo Srisuwanwattana, Poonkiat Suchonwanit, Kumutnart Chanprapaph Rituximab therapy for treatment of pemphigus in Southeast Asians. Drug Design, Development and Therapy. Vol.15, (2021), 1677-1690. doi:10.2147/DDDT.S306046 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78979
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Title
Rituximab therapy for treatment of pemphigus in Southeast Asians
Abstract
Background: Rituximab provides more effective and less adverse effects than the standard dose of corticosteroids, but evidence on its efficacy and safety in the Thai population is lacking. Objective: To evaluate the efficacy and safety of rituximab in the treatment of pemphigus and also to determine prognostic factors linked to the treatment outcomes. Methods: Pemphigus patients who received rituximab from November 2017 to December 2020 were retrospectively reviewed. The outcome was evaluated by using early (end of consolidation phase [ECP]) and late endpoints (complete remission [CR] on/off therapy, immunological remission [IR], and relapse). Adverse events were noted. Prognostic factors associated with remission and relapse were analyzed. Results: Of 53 pemphigus patients, all attained ECP within 1.61 months. Almost 80% achieved CR on therapy within a median time of 6.36 months, while 33.9% reached CR off therapy in 19.74 months. Nearly half had IR within a median time of 6.88 months. Relapse occurred in 33.3% with a median time of 14 months. In multivariate analysis, receiving rituximab within 12 months of disease duration was more likely to achieve CR off therapy and IR (hazard ratio [HR] 3.79; 95% confidence interval [CI] 1.38, 10.42; P = 0.01 and HR 2.74; 95% CI 1.12, 6.69; P = 0.027, respectively), whereas older patients and positive anti-desmoglein 1 levels at the time of CR were predictive indicators for relapse (HR 1.07; 95% CI 1.01, 1.13; P = 0.036 and HR 4.38; 95% CI 1.24, 15.46; P = 0.022, respectively). The treatment-related adverse effects occurred in 33.9%. Conclusion: Rituximab is effective and safe in Thai pemphigus patients. Early administration of rituximab was a predictor of clinical and immunological remission. Older age and persistently positive anti-Dsg1 were correlated with disease relapse.