Clinical efficacy of different doses of rituximab in the treatment of pemphigus: a retrospective study of 27 patients

The treatment of pemphigus is still challenging and some patients with pemphigus are unresponsive to conventional immunosuppressive treatments. Rituximab, a chimeric monoclonal anti-CD20 antibody, binds to the CD20 antigen on the surface of B cells and has been reported to be effective for the treatment of recalcitrant pemphigus.To compare the efficacy of different doses of rituximab in patients with pemphigus who were unresponsive to conventional therapies.Twenty-seven patients with pemphigus who received different doses of rituximab (375 mg m(-2) per infusion weekly) were analysed retrospectively. We divided the patients into two groups: group 1 (n = 12) received two infusions of rituximab and group 2 (n = 15) received three or more infusions of rituximab at 1-week intervals. The number of infusions was determined by the choice of each patient. The endpoints of the study were time to disease control, partial remission (PR) and complete remission (CR).There was no significant difference in time to achieve PR between the two groups (147 vs. 135 days, P = 0·65). However, group 2 demonstrated better outcomes than group 1 in time to CR (443 vs. 149 days, P = 0·06) and relapse rate (0% vs. 67%, P < 0·01).We conclude that three or more infusions of rituximab are more effective than two infusions for the treatment of pemphigus.