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
; 43(5): 507-518, 2021 Oct.
Article
in English
| MEDLINE | ID: covidwho-1319088
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.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pemphigus
/
Immunocompromised Host
/
Rituximab
/
COVID-19
/
Immunologic Factors
Type of study:
Diagnostic study
/
Prognostic study
/
Reviews
/
Systematic review/Meta Analysis
Limits:
Adolescent
/
Adult
/
Aged
/
Child
/
Female
/
Humans
/
Male
/
Middle aged
/
Young adult
Language:
English
Journal:
Immunopharmacol Immunotoxicol
Journal subject:
Allergy and Immunology
/
Pharmacology
/
Toxicology
Year:
2021
Document Type:
Article
Affiliation country:
08923973.2021.1953063
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