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- Presentation
Pemphigus and Pemphigoid Update: PubMed Literature Review (January 2023 - February 2024)
Description
The presentation provides an update on pemphigus and pemphigoid, summarizing significant findings from a literature review conducted on PubMed from January 2023 to February 2024. It highlights the superiority of rituximab as a first-line therapy for pemphigus compared to other treatments like prednisone and mycophenolate mofetil, emphasizing that B cell depletion via rituximab leads to higher rates of sustained remission and lower relapse rates. The presentation also notes the risks of increased infection due to rituximab but offers a decrease in cardiovascular disease risk. It briefly discusses alternative therapies such as ocrelizumab and ofotumumab. The discussion on pemphigoid includes novel therapies targeting inflammatory mediators, including dupilumab and potential combination treatments with rituximab and omalizumab. Furthermore, the emerging concern regarding drug-induced pemphigoid, especially from DPP-4 inhibitors, and immune checkpoint inhibitor-related pemphigoid is addressed. Last, the importance of monitoring patients for HSV infections, particularly in those with pemphigus, is underscored, along with the potential implications of mucous membrane pemphigoid, focusing on ocular involvement and associated malignancy risks. Overall, the session aims to enhance awareness and understanding of recent advancements in treating these complex dermatological conditions.
View moreConclusions
- B cell depletion with rituximab is highly effective and superior as a first-line therapy for pemphigus compared to traditional immunosuppressants like prednisone and mycophenolate mofetil.
- Using rituximab as a first-line treatment significantly increases the probability of achieving sustained remission compared to using it as a second or third-line option.
- Monitoring rising anti-desmoglein antibody titers can help predict relapses in pemphigus patients after treatment.
- Although rituximab increases the risk of infections, it concurrently decreases the long-term risk of cardiovascular and metabolic diseases compared to other treatment options.
- Alternative treatments to rituximab, such as ocrelizumab and ofatumumab, show promise in managing pemphigus.
- Herpes simplex virus (HSV) infections are prevalent in pemphigus lesions, necessitating monitoring and potential prophylactic treatment.
- Multiple maintenance doses of rituximab beyond 18 months appear unnecessary for most patients, as long-term remission rates are significantly higher in those treated first-line.
- Long-term treatment-free remission outcomes are more favorable when rituximab is administered as a first-line therapy.
- Combination therapies, including rituximab and omalizumab, enhance treatment efficacy for bullous pemphigoid and reduce corticosteroid dependency.
- Dipeptidyl-peptidase IV inhibitors are associated with an increased risk of bullous pemphigoid, warranting caution in patients receiving such therapy.
- Joly, P., et al. (2017). "First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial." Lancet 389: 2031-2040.
- Tedbirt, B., et al. (2024). "Sustained Remission Without Corticosteroids Among Patients With Pemphigus Who Had Rituximab as First-Line Therapy: Follow-Up of the Ritux 3 Trial." JAMA Dermatol.
- Kridin, K., et al. (2023). "Risk of infections in patients with pemphigus treated with rituximab vs. azathioprine or mycophenolate mofetil: a large-scale global cohort study." Br J Dermatol 188: 499-505.
- Kridin, K., et al. (2023). "Association of Rituximab With Risk of Long-term Cardiovascular and Metabolic Outcomes in Patients With Pemphigus." JAMA Dermatol 159(1): 56-61.
- de-la-Rosa-Fernandez, E., et al. (2023). "Ocrelizumab, an alternative to rituximab in refractory pemphigus vulgaris management." J Eur Acad Dermatol Venereol 37(9): e1104-e1106.
- Konda, D., et al. (2023). "Clinical markers of herpes simplex virus infection in patients with pemphigus vulgaris." J Am Acad Dermatol 88(3): 587-592.
- Antiga, E., et al. (2023). "S2k guidelines on the management of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome initiated by the European Academy of Dermatology and Venereology (EADV)." J Eur Acad Dermatol Venereol 37(6): 1118-1134.
- Fairley, J. A., et al. (2023). "Disease Endotypes Predict the Severity of Mucous Membrane Pemphigoid." J Invest Dermatol 143(8): 1479-1486 e1473.
- Rashid, H., et al. (2022). "Insights into clinical and diagnostic findings as well as treatment responses in patients with mucous membrane pemphigoid: A retrospective cohort study." J Am Acad Dermatol 87(1): 48-55.
- Zhao, L., et al. (2023). "Evaluation of Dupilumab in Patients With Bullous Pemphigoid." JAMA Dermatol 159: 953-960.