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TOPLINE:

Patients with pemphigus who received rituximab as first-line therapy experienced sustained remission without corticosteroids or additional rituximab infusions, an analysis showed.

METHODOLOGY:

• The short-term efficacy and safety of first-line treatment with rituximab for pemphigus were demonstrated in the Ritux 3 trial, but the rates of long-term remission are unknown.
• French investigators from 25 dermatology departments evaluated 83 patients from the Ritux 3 trial between January 1, 2010, and December 31, 2015.
• They used Kaplan-Meir curves to determine the 5- and 7-year rates of disease-free survival (DFS) without corticosteroids.

TAKEAWAY:

• Of the 83 patients, 44 were in the rituximab plus prednisone group and 39 were in the prednisone-only group, with a median follow-up of 87.3 months (7.3 years).
• Among patients in the rituximab plus prednisone group, 43 (93.5%) achieved complete remission without corticosteroids at any time during follow-up, compared with 17 patients (39%) in the prednisone-only group.
• DFS (without corticosteroid therapy) statistically favored patients in the rituximab plus prednisone group compared with patients in the prednisone-only group at follow-up times of 5 years (76.7% vs 35.3%, respectively) and 7 years (72.1% vs 35.3%; P < .001 for both associations).
• In another finding, 31 patients in the rituximab plus prednisone group reported fewer serious adverse events (SAEs) than 58 patients in the prednisone-only group, which corresponds to 0.67 and 1.32 SAEs per patient, respectively (P = .003).

IN PRACTICE:

The study findings demonstrated "the superiority of rituximab over a standard corticosteroids regimen, both in the short term and the long term," the authors wrote.

SOURCE:

Corresponding author Billal Tedbirt, MD, of the Department of Dermatology at CHU Rouen, Rouen, France, led the study, which was published online on January 24, 2024, in JAMA Dermatology.

LIMITATIONS:

Nearly 8% of patients did not attend the end of follow-up visit. Also, serum samples used to predict relapse were drawn at month 36, but the researchers said that a window of every 4-6 months might provide higher accuracy of relapses.

DISCLOSURES:

Tedbirt reported having no disclosures. Four of the study authors reported being investigators for and/or receiving personal fees from several pharmaceutical companies. The study was supported by a grant from the French Society of Dermatology.