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. 2024 Apr 29;15(3):464-472.
doi: 10.4103/idoj.idoj_558_23. eCollection 2024 May-Jun.

Comparison of the Clinical Efficacy of Rituximab Infusion and Dexamethasone-Cyclophosphamide Pulse Therapy and Their Effect on Serum Th1, Th2, and Th17 Cytokines in Pemphigus Vulgaris-A Prospective, Nonrandomized, Comparative Pilot Study

Sujay Khandpur  1 , Preeti Sharma  1 , Vinod K Sharma  2 , Dayasagar Das  3 , Alpana Sharma  3 , Neetu Bhari  1 , Vishnubhatla Sreenivas  4
Affiliations

Comparison of the Clinical Efficacy of Rituximab Infusion and Dexamethasone-Cyclophosphamide Pulse Therapy and Their Effect on Serum Th1, Th2, and Th17 Cytokines in Pemphigus Vulgaris-A Prospective, Nonrandomized, Comparative Pilot Study

Sujay Khandpur et al. Indian Dermatol Online J. .

Abstract

Background: Rituximab infusion and dexamethasone-cyclophosphamide pulse (DCP) are the two most popular regimens used in pemphigus vulgaris (PV) in India.

Objective: The present study compared the clinical efficacy of rituximab and DCP in Indian PV patients and their effects on serum Th1,2, and 17 cytokine levels.

Materials and methods: A total of 37 patients received DCP (Group A, n = 22) or rituximab (Group B, rheumatoid arthritis protocol (n = 15)) as per patients' preference. They were monitored for clinical response, adverse events (AEs), changes in serum anti-desmoglein-1,3 antibody titers and Th1,2 and 17 cytokine levels at baseline and weeks 20 and 52.

Results: The proportion of patients attaining disease control, remission, and relapse in groups A and B were 82% and 93%; 73% and 93%; and 27% and 50%, respectively, after a median duration of 2 months each for disease control; 4 and 4.5 months for remission; and 5 and 7 months for relapse post remission. The musculoskeletal AEs were the highest in the two groups. Significant and comparable decreases in anti-dsg1 and 3 titers from baseline to weeks 20 and 52 were observed in both groups. Th1 and Th17 cytokine levels decreased, while Th2 cytokines increased post-treatment in both groups. However, no correlation was found between change in body surface area of involvement by PV and anti-dsg titers and cytokine levels before and after therapy in both groups.

Conclusion: Comparable clinical efficacy between DCP and rituximab was observed.

Keywords: Rituximab; cytokines; dexamethasone-cyclophosphamide pulse; pemphigus vulgaris.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow of patients in the study
Figure 2
Figure 2
Graph depicting proportion of adverse events in the two groups classified as per organ system criteria. The P values were calculated by Chi-square test
See this image and copyright information in PMC

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Cited by

  • Consensus Based Indian Guidelines for the Management of Pemphigus Vulgaris and Pemphigus Foliaceous.
    De D, Mehta H, Shah S, Ajithkumar K, Barua S, Chandrashekar L, Chatterjee M, Gupta V, Khandpur S, Khullar G, Kolalapudi SA, Kumar S, Neema S, Pandhi D, Poojary S, Rai R, Rajagopalan M, Rao R, Shah B, Singal A, Thakur V, Vinay K, Aggrawal A, De A, Mukherjee S, Prinja S, Mahajan R, Handa S. De D, et al. Indian Dermatol Online J. 2024 Dec 26;16(1):3-24. doi: 10.4103/idoj.idoj_1059_24. eCollection 2025 Jan-Feb. Indian Dermatol Online J. 2024. PMID: 39850690 Free PMC article.

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