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American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 4/2022

17-05-2022 | Bullous Pemphigoid | Original Research Article

Clinical Effectiveness and Safety of Initial Combination Therapy with Corticosteroids and Rituximab in Bullous Pemphigoid: A Retrospective Cohort Study

Authors: Yun-Ju Tsai, Yung-Tsu Cho, Chia-Yu Chu

Published in: American Journal of Clinical Dermatology | Issue 4/2022

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Abstract

Background

Rituximab is a potential initial adjuvant therapy for bullous pemphigoid, yet clinical experience is scarce.

Objective

We aimed to examine the clinical outcomes and safety of initial combination therapy with systemic corticosteroids and adjuvant rituximab for the treatment of bullous pemphigoid.

Methods

A retrospective cohort study was performed on 84 patients with bullous pemphigoid, who received systemic corticosteroids with or without initial adjuvant rituximab therapy (defined as rituximab use within 12 weeks after initiation of systemic corticosteroids).

Results

Among the 84 patients included (37 received systemic corticosteroids with rituximab and 47 were treated with systemic corticosteroids without rituximab), the median time to complete remission on minimal therapy or off therapy was 215 days (95% confidence interval 176.9–253.1) in patients receiving rituximab vs 529 days (95% confidence interval 338.6–719.4) in those not receiving rituximab. A Cox regression analysis showed an increased probability of reaching complete remission on minimal therapy or off therapy with the combined therapy (hazard ratio = 2.28 [1.28–4.07], p = 0.005) after age, Bullous Pemphigoid Disease Activity Index score, and underlying diseases were controlled. In multivariate logistic/linear regressions, initial adjuvant rituximab therapy was associated with a higher complete remission rate (odds ratio = 6.63 [2.09–21.03]) and lower cumulative prednisolone (mg)/body weight (kg) (B = −24.86 [−44.06 to −8.29]) within 48 weeks. Risk of hospitalization for infection was not elevated in the group treated with adjuvant rituximab.

Conclusions

Rituximab use as adjuvant therapy within 12 weeks after initiation of systemic corticosteroids was associated with a faster and higher rate of achieving complete remission on minimal therapy or off therapy, as well as a significant corticosteroid-sparing effect and a comparable safety profile in this retrospective study. Hence, initial combination therapy with corticosteroids and adjuvant rituximab could serve as an effective treatment option for bullous pemphigoid, but this requires confirmation in randomized controlled studies.
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Metadata
Title
Clinical Effectiveness and Safety of Initial Combination Therapy with Corticosteroids and Rituximab in Bullous Pemphigoid: A Retrospective Cohort Study
Authors
Yun-Ju Tsai
Yung-Tsu Cho
Chia-Yu Chu
Publication date
17-05-2022
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 4/2022
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.1007/s40257-022-00688-x

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