Low-Dose Rituximab for Bullous Pemphigoid. Protocol and Single-Center Experience.

BACKGROUND: Low-dose rituximab is a protocol used in several autoimmune diseases, that has also shown to be effective and safe in pemphigus vulgaris. OBJECTIVES: To study whether low-dose rituximab is also effective for bullous pemphigoid. METHODS: Patients with BP were treated with a single cycle of two infusions of rituximab 500mg at an interval of 2 weeks. Early and late end points were monitored. RESULTS: Six patients, five males and a female, with a mean age of 78.6 years (range 65-89) and a mean history of BP of 6.7 months (range 2-16) were included. A rapid and marked response was observed after a single cycle of treatment, with a mean time to disease control and to end of consolidation phase of 1.9 (range 1-3), and 4 weeks (range 3-5), respectively. Four patients achieved a late end point at a mean of 15.75 weeks (range 13-20). Three of them achieved partial remission with no therapy (two patients) or with minimal therapy (one patient), and one of them achieved complete remission with no therapy. One patient has 6 weeks of clinical follow-up after rituximab administration. The remaining patient relapsed 4 weeks after the rituximab treatment, and remains in complete remission with more than minimal therapy. One patient had a herpetic gingivostomatitis related to rituximab. CONCLUSIONS: Low-dose rituximab for BP achieved acceptable remission rates and steroid-sparing activity, with a better safety profile and a lower cost, compared to standard doses. This pilot study suggests that low-dose rituximab could be a therapeutic option for BP.

Low-Dose Rituximab for Bullous Pemphigoid. Protocol and Single-Center Experience. / [Artículo traducido] Baja dosis de rituximab para penfigoide ampolloso. Protocolo y experiencia de un único centro.

BACKGROUND: Low-dose rituximab is a protocol used in several autoimmune diseases, that has also shown to be effective and safe in pemphigus vulgaris. OBJECTIVES: To study whether low-dose rituximab is also effective for bullous pemphigoid. METHODS: Patients with BP were treated with a single cycle of two infusions of rituximab 500 mg at an interval of 2 weeks. Early and late end points were monitored. RESULTS: Six patients, five males and a female, with a mean age of 78.6 years (range 65-89) and a mean history of BP of 6.7 months (range 2-16) were included. A rapid and marked response was observed after a single cycle of treatment, with a mean time to disease control and to end of consolidation phase of 1.9 (range 1-3), and 4 weeks (range 3-5), respectively. Four patients achieved a late end point at a mean of 15.75 weeks (range 13-20). Three of them achieved partial remission with no therapy (two patients) or with minimal therapy (one patient), and one of them achieved complete remission with no therapy. One patient has 6 weeks of clinical follow-up after rituximab administration. The remaining patient relapsed 4 weeks after the rituximab treatment, and remains in complete remission with more than minimal therapy. One patient had a herpetic gingivostomatitis related to rituximab. CONCLUSIONS: Low-dose rituximab for BP achieved acceptable remission rates and steroid-sparing activity, with a better safety profile and a lower cost, compared to standard doses. This pilot study suggests that low-dose rituximab could be a therapeutic option for BP.

A propósito de un caso de neumonía por SARS-CoV-2 tratado con inhibidor de IL-1 / About a case of of SARS-CoV-2 pneumonia treated with IL-1 inhibitor

En la ciudad de Wuhan (provincia de Hubei, China), a finales de diciembre de 2019 se notificaron los primeros casos de una infección respiratoria causada que posteriormente se identificó como un nuevo coronavirus (SARS-CoV-2). Este cuadro se presenta como un síndrome respiratorio leve, en la mayoría de los casos, o una enfermedad más grave, con la aparición de opacidades pulmonares, con dificultad respiratoria y necesidad de ventilación mecánica no invasiva o ingreso en Unidades de Cuidados Intensivos. Estos pacientes con una enfermedad más grave debutan con una tormenta de citoquinas y activación de monocitos/macrófagos. Esta respuesta se observa igualmente en pacientes con linfohistiocitosis hemofagocítica secundaria, infecciones virales o síndrome de activación de macrófagos, enfermedades autoinmunitarias sistémicas y autoinflamatorias. Lo cual constituye una justificación para utilizar medicamentos específicamente dirigidos a reducir la tormenta de citoquinas. En cuanto al tratamiento, la evidencia es muy limitada, no pudiéndose establecer unas recomendaciones consistentes. En este caso clínico vamos a presentar un paciente con evolución satisfactoria tras el uso de inhibidores de la interleucina 1

The first cases of a respiratory infection caused by what was later identified as a new coronavirus (SARS-CoV-2) were reported in Wuhan City, Hubei Province, China in late December 2019. This picture presents as a mild respiratory syndrome, in most cases, or a more serious disease, with the appearance of pulmonary opacities, with respiratory distress and the need for non-invasive mechanical ventilation or admission to intensive care units. These more severely ill patients debut with a cytokine storm and monocyte / macrophage activation. This response is also seen in patients with secondary hemophagocytic lymphohistiocytosis, viral infections, or macrophage activation syndrome, systemic autoimmune, and autoinflammatory diseases. This constitutes a justification for using drugs specifically aimed at reducing the cytokine storm. Regarding treatment, the evidence is very limited, and consistent recommendations cannot be established. In this clinical case, we are going to present a patient with a satisfactory evolution after the use of interleukin inhibitors 1