Effectiveness and side effects of anti-CD20 therapy for autoantibody-mediated blistering skin diseases: A comprehensive survey of 71 consecutive patients from the Initial use to 2007

Jennifer D Peterson¹, Lawrence S Chan^2,3,4

¹Department of Dermatology, Texas Tech University Health Sciences Center at Lubbock, Lubbock, TX, USA; ²Department of Dermatology; ³Department of Microbiology/Immunology, University of Illinois at Chicago, Chicago, IL, USA; ⁴Medicine Service, Jesse Brown VA Medical Center, Chicago, IL, USA

Abstract: In order to examine the efficacy and side effects of the monoclonal antibody anti-CD20 (rituximab) on autoimmune blistering skin diseases, we performed a comprehensive survey of 71 consecutive patients from initial use up to 2007, using the PubMed database. A heterogeneous group of patients, including 51 patients with pemphigus vulgaris, one with pemphigus vegetans, nine with pemphigus foliaceus, five with paraneoplastic pemphigus, four with epidermolysis bullosa acquisita, and one with both bullous pemphigoid and graft vs host disease was included in this survey. Overall the monoclonal antibody seems to be effective in that 69% of patients showed complete response, 25% of patients showed partial response, whereas 6% of patients showed progressive disease. Six deaths occurred in association with the treatment, with four of these deaths in patients with paraneoplastic pemphigus, a disease characteristically resistant to conventional medication and with a high mortality rate. Of note, 11 patients who received combined rituximab and intravenous immune globulin treatments had the best outcome: complete response without any serious side effects. Therefore further investigation on rituximab with controlled clinical trial is a worthy pursuit.

Keywords: blistering diseases, skin, anti-CD20, pemphigus, epidermolysis bullosa acquisita