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A systematic review on efficacy, safety, and treatment-durability of low-dose rituximab for the treatment of Pemphigus: special focus on COVID-19 pandemic concerns.
Immunopharmacol Immunotoxicol. 2021 Jul 21 [Online ahead of print]II

Abstract

BACKGROUND

Rituximab is a FDA-approved monoclonal antibody for adults with moderate to severe potentially life-threatening pemphigus vulgaris. Recent studies have focused on assessments of efficacy and safety of low-dose rituximab (<2 gram in each cycle).

METHOD

Databases were searched from 2010 to 2020 (last update: 1 June 2020).

RESULT

Nine studies were entered; including180 cases (92: women, 88: men, age range: 9-83 years). The dosages of each Rituximab cycle varied between ultra-low-dose (≤500 mg for a cycle, either multiple infusions or a single infusion), low-dose (2 × 375 mg/m2 or 2 × 500 mg) and modified-dose (3 × 375 mg/m2 or 3 × 500 mg). The efficacy and safety of Rituximab in the studies are known by the recovery time, relapse time, and side events. According to the studies, 2 × 500 can lead to complete remission in a broad range, from 35 to 82%. These differences might be explained by different end-points and variable cumulative corticosteroid dosage after RTX administration. Although the studies showed that low dose RTX is efficient, there are some controversies regarding the choosing low-dose for severe patients.

CONCLUSION

Considering the effectiveness of low-dose, intermediate dose, and ultra-low-dose protocols of Rituximab in inducing remission in pemphigus disease and considering factors such as cost of therapy, and the need to induce a minimum of immunosuppression for a minimum duration in the COVID-19 pandemic, suggested to use low-dose Rituximab protocol (2 infusions of 500 mg Rituximab: interval of 2 weeks) to induce the remission in mild-to-moderate pemphigus patients.

Authors+Show Affiliations

Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Department of Dermatology, Babol University of Medical Sciences, Babol, Iran.Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34287098

Citation

Tavakolpour, Soheil, et al. "A Systematic Review On Efficacy, Safety, and Treatment-durability of Low-dose Rituximab for the Treatment of Pemphigus: Special Focus On COVID-19 Pandemic Concerns." Immunopharmacology and Immunotoxicology, 2021, pp. 1-12.
Tavakolpour S, Aryanian Z, Seirafianpour F, et al. A systematic review on efficacy, safety, and treatment-durability of low-dose rituximab for the treatment of Pemphigus: special focus on COVID-19 pandemic concerns. Immunopharmacol Immunotoxicol. 2021.
Tavakolpour, S., Aryanian, Z., Seirafianpour, F., Dodangeh, M., Etesami, I., Daneshpazhooh, M., Balighi, K., Mahmoudi, H., & Goodarzi, A. (2021). A systematic review on efficacy, safety, and treatment-durability of low-dose rituximab for the treatment of Pemphigus: special focus on COVID-19 pandemic concerns. Immunopharmacology and Immunotoxicology, 1-12. https://doi.org/10.1080/08923973.2021.1953063
Tavakolpour S, et al. A Systematic Review On Efficacy, Safety, and Treatment-durability of Low-dose Rituximab for the Treatment of Pemphigus: Special Focus On COVID-19 Pandemic Concerns. Immunopharmacol Immunotoxicol. 2021 Jul 21;1-12. PubMed PMID: 34287098.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A systematic review on efficacy, safety, and treatment-durability of low-dose rituximab for the treatment of Pemphigus: special focus on COVID-19 pandemic concerns. AU - Tavakolpour,Soheil, AU - Aryanian,Zeinab, AU - Seirafianpour,Farnoosh, AU - Dodangeh,Milad, AU - Etesami,Ifa, AU - Daneshpazhooh,Maryam, AU - Balighi,Kamran, AU - Mahmoudi,Hamidreza, AU - Goodarzi,Azadeh, Y1 - 2021/07/21/ PY - 2021/7/21/entrez PY - 2021/7/22/pubmed PY - 2021/7/22/medline KW - COVID-19 KW - Pemphigus KW - autoimmune bullous skin disorder KW - low-dose KW - rituximab KW - systematic review KW - ultra-low-dose KW - under-standard dose SP - 1 EP - 12 JF - Immunopharmacology and immunotoxicology JO - Immunopharmacol Immunotoxicol N2 - BACKGROUND: Rituximab is a FDA-approved monoclonal antibody for adults with moderate to severe potentially life-threatening pemphigus vulgaris. Recent studies have focused on assessments of efficacy and safety of low-dose rituximab (<2 gram in each cycle). METHOD: Databases were searched from 2010 to 2020 (last update: 1 June 2020). RESULT: Nine studies were entered; including180 cases (92: women, 88: men, age range: 9-83 years). The dosages of each Rituximab cycle varied between ultra-low-dose (≤500 mg for a cycle, either multiple infusions or a single infusion), low-dose (2 × 375 mg/m2 or 2 × 500 mg) and modified-dose (3 × 375 mg/m2 or 3 × 500 mg). The efficacy and safety of Rituximab in the studies are known by the recovery time, relapse time, and side events. According to the studies, 2 × 500 can lead to complete remission in a broad range, from 35 to 82%. These differences might be explained by different end-points and variable cumulative corticosteroid dosage after RTX administration. Although the studies showed that low dose RTX is efficient, there are some controversies regarding the choosing low-dose for severe patients. CONCLUSION: Considering the effectiveness of low-dose, intermediate dose, and ultra-low-dose protocols of Rituximab in inducing remission in pemphigus disease and considering factors such as cost of therapy, and the need to induce a minimum of immunosuppression for a minimum duration in the COVID-19 pandemic, suggested to use low-dose Rituximab protocol (2 infusions of 500 mg Rituximab: interval of 2 weeks) to induce the remission in mild-to-moderate pemphigus patients. SN - 1532-2513 UR - https://www.unboundmedicine.com/medline/citation/34287098/A_systematic_review_on_efficacy,_safety,_and_treatment-durability_of_low-dose_rituximab_for_the_treatment_of_Pemphigus:_special_focus_on_COVID-19_pandemic_concerns. L2 - https://www.tandfonline.com/doi/full/10.1080/08923973.2021.1953063 DB - PRIME DP - Unbound Medicine ER -
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