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Rituxan with IV immune globulin results in long-term pemphigus vulgaris remission

A combination of IV immune globulin and Rituxan to treat patients with pemphigus vulgaris resulted in 10-year remissions, according to follow-up study results published in The New England Journal of Medicine.

“Rituxan has proven to be an effective therapy for rheumatoid arthritis and [granulomatosis with polyangiitis (GPA)/microscopic polyangiitis (MPA)] in clinical trials,” Diana M. Chen, MD, MBA, FAAD, senior medical director at Genentech, told Healio.com/Dermatology. “The 10-year outcome of [these patients] would suggest that Rituxan is also effective in pemphigus vulgaris.”

Diana M. Chen

In 2006, researchers conducted a study in which 11 patients with severe and recalcitrant pemphigus vulgaris were treated with a combination of IV immune globulin and Rituxan (rituximab, Genentech).

They received 10 infusions of rituximab over 6 months and monthly IV immune globulin until B-cell levels returned to normal. The patients had achieved complete remission, which was sustained for more than 3 years.

A 10-year follow-up study of 10 of the 11 patients (mean, 131.7 months) was conducted.

All patients remained in remission, and no recurrence of disease was reported. There were no short-term or long-term adverse events reported, and no need for hospitalization.

No other autoimmune disease, cancer or death was reported with treatment of rituximab or IV immune globulin. IgG autoantibodies had become undetectable in the patients in 2006. The patients also reached normal counts of CD19+ B cells

“The mechanisms by which the combination of treatments produced 10-year remissions are not known,” the study researchers concluded. “Whereas rituximab destroyed pathogenic B cells, IV immune globulin may have helped to restore lost immune regulation and normal physiology.”

“We look forward to the results of our company-sponsored phase 3 study with the goal of proving a much-needed treatment option for pemphigus vulgaris patients,” Chen said. – by Bruce Thiel

Disclosure: Healio.com/Dermatology was unable to determine the researchers’ relevant financial disclosures at time of publication.