Clinical investigators from University of Pennsylvania, Perelman School of Medicine, reveal that a lymphoma-dose regimen of rituximab, a medication regularly used to treat lymphoma and rheumatoid arthritis, is more likely to put patients with pemphigus into complete remission as compared to a rheumatoid arthritis (RA) regimen of the same medication.
The study’s findings, recently published in JAMA Dermatology, have direct implications for patient care.
What is Pemphigus?
Pemphigus is an autoimmune disease mediated by B cells and which causes painful blisters and sores on the skin and mucous membranes. A rare chronic autoimmune condition, it can be fatal if not treated. Treatment for pemphigus, most commonly through an oral medication, was often slow and doesn’t result in complete remission.
Use of Rituximab
When rituximab (Genentech/Roche), an antibody which was first used to treat B cell lymphoma, became a treatment for pemphigus vulgaris, clinicians could choose to prescribe either a “lymphoma dose” or an “RA dose.” A lymphoma dose regimen of rituximab is a more aggressive approach to treatment compared to the dosing method for patients with rheumatoid arthritis. The Food and Drug Administration (FDA) has now an approved dosing regimen for pemphigus vulgaris, but it closely resembles the often less-effective RA dose. While both lymphoma and RA dosing approaches deplete B cells that cause disease, the lymphoma regimen considers a person’s height and weight to determine a dose and is given weekly for four weeks. A RA dose is a fixed dose of two 1000 mg infusions given two weeks a part. The odds of complete remission on a lymphoma regimen were 2.7 times greater compared to patients on a RA regimen suggesting that the FDA-approved regimen for pemphigus may not be ideal.
The Penn team study revealed that the more aggressive lymphoma regimen offers a pemphigus patient a better chance for complete remission off oral immune suppressants.
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