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Review
. 2019 Sep;32(5):e13016.
doi: 10.1111/dth.13016. Epub 2019 Jul 24.

Iranian guideline for rituximab therapy in pemphigus patients

Maryam Daneshpazhooh  1 , Kamran Balighi  1 , Hamidreza Mahmoudi  1 , Soheil Tavakolpour  1 , Robabeh Abedini  1 , Tahereh Soori  1 , Amir-Houshang Ehsani  1 , Maryam Ghiasi  1 , Pedram Noormohammadpour  1 , Narges Ghandi  1 , Vahideh Lajevardi  1 , Ali Sadeghinia  1 , Maryam Nasimi  1 , Arghavan Azizpour  1 , Cheyda Chams-Davatchi  1
Affiliations
Review

Iranian guideline for rituximab therapy in pemphigus patients

Maryam Daneshpazhooh et al. Dermatol Ther. 2019 Sep.

Abstract

Pemphigus vulgaris (PV) is an autoimmune blistering disease affecting the skin and/or mucosa. Rituximab (RTX) has been approved recently by US FDA as an effective and safe treatment of PV. The high incidence of PV in Iran encouraged our team to prepare a consensus guideline for RTX administration based on literature review and a decade experience of an expert panel. RTX is recommended for the treatment of new cases of PV as well as patients not responding to conventional therapy. Contraindications include history of anaphylaxis or IgE-mediated hypersensitivity to murine proteins of RTX, severe active infections, pregnancy, breastfeeding, severe heart failure, and arrhythmia. Prophylactic antiviral therapy is recommended in patients at risk of reactivation of HBV and isoniazid for those at risk of reactivation of tuberculosis. Concomitant use of systemic corticosteroids is recommended as a rule. Except for methotrexate, the combination with other immunosuppressive drugs is discouraged. Intravenous immunoglobulin is recommended for those at risk of infections or with extensive disease. The recommended dosage of RTX for the first cycle is 2 g either 500 mg weekly or 1 g biweekly. There is no general consensus whether the next doses of RTX be administered upon relapse or as maintenance therapy. We strongly recommend RTX sooner in the course of pemphigus.

Keywords: guideline; pemphigus vulgaris; pregnancy; rituximab.

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References

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