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ePaper created 2014-09-15, 12:31:02 | version 1.32.01
improvement, while 53% of the patients achieved complete remission.[4] The treatment had an excellent safety profile and relapse rate was not significantly higher than at higher dosages. Yearly about 20 pemphigus patients, referred from all over the Netherlands, are treated with rituximab in Groningen. Soon after our publication, a study from a group in Rome appeared using the rheumatoid arthritis dose regime of 2x1000 mg that showed a complete remission rate of 86% without the need for azathioprin or other immunosuppressive agents.[5] Omission of the immunosuppressive agent with its usual side effects, and the better remission rate, is the reason that in 2012 we changed to the higher-dose rituximab to compare it with the historical low dose series. Rituximab might become the therapy of first choice for pemphigus if the results of a forthcoming randomized trial in France are encouraging. Moreover, there are several second and third generation fully human or higher affinity anti-CD20 mAbs (ofatumumab, ocrelizumab, veltuzumab) being developed by several companies, for which pemphigus may become a labelled indication. These advancements may make this chronic disease curable by insured medical intervention. References 1. Borradori L, Lombardi T, Samson J, et al. Anti-CD20 monoclonal antibody (rituximab) for refractory erosive stomatitis secondary to CD20(+) follicular lymphoma-associated paraneoplastic pemphigus. Arch Dermatol 2001; 137: 269-72. 2. Ahmed AR, Spigelman Z, Cavacini LA, et al. Treatment of pemphigus vulgaris with rituximab and intravenous immune globulin. N Engl J Med 2006; 355: 1772-9. 3. Joly P, Mouquet H, Roujeau JC, et al. A single cycle of rituximab for the treatment of severe pemphigus. N Engl J Med 2007: 357: 545-52. 4. Horváth B, Huizinga J, Pas HH, et al. Low-dose rituximab is effective in pemphigus. Br J Dermatol. 201; 166: 405-12. 5. Cianchini G, Lupi F, Masini C, et al. Therapy with rituximab for autoimmune pemphigus: results from a single-center observational study on 42 cases with long-term follow-up. J Am Acad Dermatol. 2012; 67: 617-22. 61 BWEADVSMGFINCORR:Opmaak 1 21-07-2014 17:40 Pagina 61