Rituximab tied to better disease control in mucous membrane pemphigoid

Last Updated: 2016-03-25

By Will Boggs MD

NEW YORK (Reuters Health) - Rituximab added to conventional immunosuppressive therapy appears to enhance disease control in patients with mucous membrane pemphigoid (MMP), according to a retrospective review.

"For those of us who treat these rare autoimmune blistering diseases such as MMP, the impact of B cell depletion therapy with rituximab has been quite dramatic," Dr. Ron Feldman from Emory University School of Medicine, Atlanta, Georgia told Reuters Health. "It is difficult to complete large randomized controlled trials with such rare populations, but growing evidence suggests that rituximab may be quite effective and as safe as conventional therapy."

Conventional immunosuppressive therapies have been used to halt disease progression and prevent further scarring and morbidity in MMP, but there is limited data for the use of rituximab in these patients.

Dr. Feldman's team report the outcomes of 24 MMP patients treated with rituximab versus 25 MMP patients treated with conventional immunosuppression in an article online February 27 in the Journal of the American Academy of Dermatology.

Follow-up ranged from 6 to 71 months (mean, 28.5 months) in the rituximab group and from 6 to 138 months (mean, 44.46 months) in the conventional immunosuppression group.

All 24 patients in the rituximab group achieved disease control (after a mean 10.17 months), compared with 10 patients (40%) in the conventional immunosuppression group (after a mean 37.7 months).

"Rituximab was effective even in patients who had involvement with ocular and laryngeal disease," Dr. Feldman said. "These sites typically are refractory to treatment and can cause significant morbidities from scarring."

At last follow-up, 73% of the rituximab patients and 52% of the conventional immunosuppression patients were off prednisone.

Ten patients (42%) in the rituximab relapsed after a mean 9.6 months of disease control, compared with three patients (30%) in the conventional immunosuppression group after a mean 2.3 months of disease control.

Five of the 10 relapsed rituximab patients achieved disease control after further rituximab treatment, and all three conventional immunosuppression patients achieved disease control after increases in their immunosuppression regimens.

Adverse event rates did not differ significantly between the two treatment groups.

"For this rare disorder that encompasses several subspecialties, including dermatology, ENT, ophthalmology, GI, rituximab may offer a significant benefit if added to conventional therapy to induce clinical remission and possible increased steroid sparing," Dr. Feldman concluded.

"Some patients may require more than one course of therapy and perhaps more-tailored rituximab protocols for blistering diseases may be more appropriate in the long run," Dr. Feldman said.

SOURCE: bit.ly/1WNUaO9

J Am Acad Dermatol 2016.