Comparing early and late treatments with rituximab in pemphigus vulgaris: which one is better?

During the last decade, successfully treatment of patients diagnosed with pemphigus vulgaris (PV) with rituximab (RTX) was reported by several authors. The present study has been designed to compare the clinical outcomes and RTX-related side effects between the two groups of early treated (≤ 6 months) and lately treated PV (> 6 months) patients with RTX. We did a retrospective study between Oct 2014 and Jun 2016 to compare the short-term efficacy and safety of RTX in PV diagnosed patients. The primary and secondary endpoints were complete/partial remission of disease and safely tapering of corticosteroids without disease relapse, respectively. Among the 250 RTX exposed PV patients in the selected period, 107 were successfully followed for the mean 19.71 ± 16.78 months. Twenty-four and eighty three have categorized as the early (≤ 6 months after diagnosis) or lately (> 6 months after diagnosis) RTX-treated patients, respectively. A higher rate of complete remission, longer time lasting remission phase, and a lower number of adjuvants were associated with early RTX treatment. Early treatment with RTX might be associated with improvement of clinical effects, but does not seems to be safer than lately RTX therapy. Those in the early treated group may not only have a higher chance to achieve complete remission, but also experience a longer time of disease remission with lower cumulative doses of adjuvant therapy.