| Treatment of severe pemphigus with protein A immunoadsorption, rituximab and intravenous immunoglobulins. | |
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MedLine Citation:
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PMID: 18070210 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Pemphigus is a life-threatening autoimmune blistering disease usually treated with high-dose corticosteroids and other immunosuppressants. However, this regimen may prove inadequate in severe cases and cause dangerous side-effects. While protein A immunoadsorption (PAIA) induces a rapid remission in severe pemphigus, the disease usually recurs once the treatment is stopped. In contrast, anti-CD20 antibody rituximab has a delayed onset of action but may lead to a long-term remission of pemphigus. OBJECTIVE: To develop a treatment protocol combining the rapid remission induced by PAIA with the positive long-term effects of rituximab. PATIENTS AND METHODS: Five patients with pemphigus vulgaris and two patients with pemphigus foliaceus were treated with a combination of PAIA, rituximab and conventional immunosuppressants. Patients who failed to respond to this therapy subsequently received intravenous immunoglobulins (IVIg). RESULTS: All seven patients showed a sharp decline of circulating autoantibody levels and rapid improvement of cutaneous and mucosal lesions within 4 weeks of therapy. Long-term remission was induced in three patients and one further patient showed a partial improvement of his disease. The three remaining patients who could not be weaned off PAIA and remained resistant to rituximab treatment showed a good response to IVIg therapy. CONCLUSION: The combination of PAIA and rituximab induces a rapid and durable remission in a subset of patients with severe pemphigus. IVIg therapy appears to be a good treatment option for rituximab nonresponders. |
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Authors:
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I Shimanovich; M Nitschke; C Rose; J Grabbe; D Zillikens |
Publication Detail:
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Type: Journal Article Date: 2007-12-06 |
Journal Detail:
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Title: The British journal of dermatology Volume: 158 ISSN: 0007-0963 ISO Abbreviation: Br. J. Dermatol. Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-01-24 Completed Date: 2008-04-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0004041 Medline TA: Br J Dermatol Country: England |
Other Details:
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Languages: eng Pagination: 382-8 Citation Subset: IM |
Affiliation:
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Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. shim92@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Antibodies, Monoclonal / administration & dosage* Combined Modality Therapy / methods Drug Therapy, Combination Female Humans Immunoglobulins, Intravenous / administration & dosage* Immunologic Factors / administration & dosage* Immunosorbent Techniques* Male Middle Aged Pemphigus / drug therapy, therapy* Staphylococcal Protein A / administration & dosage* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Monoclonal; 0/Immunoglobulins, Intravenous; 0/Immunologic Factors; 0/Staphylococcal Protein A; 0/rituximab |
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