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A prospective study on clinical response and cell-mediated immunity of pemphigus patients treated with rituximab

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Abstract

Rituximab has recently been reported in retrospective studies to be effective in pemphigus at the dosing schedule used for treating rheumatoid arthritis (RA) of two 1,000 mg infusions 2 weeks apart. While the effect of rituximab on B cells has been well described, its effect on global T cell function has not been assessed. Ten patients who received RA dosage rituximab were prospectively assessed for clinical response. Immunological response including autoantibody titers, CD20+ B cell, and CD4+ T cell counts was assessed pre- and post-treatment. The CD4+ T cell function was determined by a novel assay measuring intracellular ATP levels in response to mitogenic stimulus. At 6 months, 90 % of patients achieved remission. Disease control and remission were achieved at median times of 1 and 3.7 months, respectively. There was a 67 % relapse rate during an average follow-up of 22 months. Global CD4+ T cell numbers and function were preserved 3 months after rituximab. A single cycle of RA dosage rituximab with concomitant immunosuppression is effective in pemphigus. We did not find an effect on total CD4+ T cell numbers or function 3 months after treatment.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Dermatology, Rabin Medical Center, Beilinson Hospital, 49100, Petach Tikva, Israel

    Y. A. Leshem, M. David, E. Hodak, M. Eskin-Schwartz & D. Mimouni

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Y. A. Leshem, M. David, E. Hodak & D. Mimouni

  3. Medical Division, Leumit Health Services, Tel-Aviv, Israel

    D. A. Waitman & D. Vardy

  4. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    D. Vardy

  5. Tissue Typing Laboratory, Rabin Medical Center, Petach Tikva, Israel

    M. Israeli

  6. Department of Dermatology, Rambam Medical Center, Haifa, Israel

    R. Bergman

  7. The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    R. Bergman

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  1. Y. A. Leshem
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  2. M. David
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  3. E. Hodak
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  4. D. A. Waitman
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  5. D. Vardy
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  6. M. Israeli
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  7. M. Eskin-Schwartz
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  8. R. Bergman
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  9. D. Mimouni
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Correspondence to Y. A. Leshem.

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Leshem, Y.A., David, M., Hodak, E. et al. A prospective study on clinical response and cell-mediated immunity of pemphigus patients treated with rituximab. Arch Dermatol Res 306, 67–74 (2014). https://doi.org/10.1007/s00403-013-1355-4

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  • DOI: https://doi.org/10.1007/s00403-013-1355-4

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