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Review
. 2025 Jul 25:16:1605243.
doi: 10.3389/fimmu.2025.1605243. eCollection 2025.

Efficacy and safety of low dose rituximab in pemphigus: an updated systematic review and meta-analysis

Si-Han Liu  1 , Si-Hang Wang  1 , Ya-Gang Zuo  1
Affiliations
Review

Efficacy and safety of low dose rituximab in pemphigus: an updated systematic review and meta-analysis

Si-Han Liu et al. Front Immunol. .

Abstract

Objective: To evaluate the efficacy and safety of low-dose rituximab (RTX) in the treatment of pemphigus.

Methods: A systematic literature search was conducted across PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov to identify eligible studies. Primary efficacy outcomes included complete remission (CR), relapse rates, time to disease control (TDC), time to CR, and cumulative corticosteroid dose. Safety outcomes were assessed by meticulously documenting adverse events (AEs) and concomitant medications reported in each study.

Results: The final analysis incorporated five comparative studies and nine single-arm studies investigating the efficacy and safety outcomes of low-dose RTX. Comparative data revealed no statistically significant differences between the high-dose and low-dose RTX groups in CR, relapse rates, TDC, time to CR, and cumulative corticosteroid dose. In single-arm studies, pooled CR and relapse rates were 63.2% and 28.6%, respectively. No fatal events were reported; however, severe AEs, including pneumonia and sepsis, were documented in the low-dose RTX cohort.

Conclusion: Low-dose RTX exhibited comparable clinical efficacy to high-dose RTX regimens in pemphigus management. However, clinicians should remain vigilant for potential AEs associated with low-dose RTX infusion.

Keywords: meta-analysis; pemphigus; rituximab; safety; treatment outcome.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of studies selection process.
Figure 2
Figure 2
Forest plot of CR rate. (A) Five comparative studies (B) Three comparative studies comparing 2 infusions of 1000mg versus 500mg RTX (C) Nine single-arm studies (D) Four single-arm studies using two infusions of 500mg RTX.
Figure 3
Figure 3
Forest plot of relapse rate. (A) Four comparative studies (B)Three comparative studies comparing 2 infusions of 1000mg versus 500mg RTX (C) Seven single-arm studies (D) Three single-arm studies using two infusions of 500mg RTX.
Figure 4
Figure 4
Forest plot of (A) time to disease control (B) time to CR (C) Cumulative corticosteroid dose.
See this image and copyright information in PMC

References

    1. Schmidt E, Kasperkiewicz M, Joly P. Pemphigus. Lancet (London England). (2019) 394:882–94. doi: 10.1016/S0140-6736(19)31778-7, PMID: - DOI - PubMed
    1. Kasperkiewicz M, Ellebrecht CT, Takahashi H, Yamagami J, Zillikens D, Payne AS, et al. Pemphigus. Nat Rev Dis primers. (2017) 3:17026. doi: 10.1038/nrdp.2017.26, PMID: - DOI - PMC - PubMed
    1. Buonavoglia A, Leone P, Dammacco R, Di Lernia G, Petruzzi M, Bonamonte D, et al. Pemphigus and mucous membrane pemphigoid: An update from diagnosis to therapy. Autoimmun Rev. (2019) 18:349–58. doi: 10.1016/j.autrev.2019.02.005, PMID: - DOI - PubMed
    1. Zhao W, Wang J, Zhu H, Pan M. Comparison of guidelines for management of pemphigus: a review of systemic corticosteroids, rituximab, and other immunosuppressive therapies. Clin Rev Allergy Immunol. (2021) 61:351–62. doi: 10.1007/s12016-021-08882-1, PMID: - DOI - PubMed
    1. Frampton JE. Rituximab: A review in pemphigus vulgaris. Am J Clin Dermatol. (2020) 21:149–56. doi: 10.1007/s40257-019-00497-9, PMID: - DOI - PubMed

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