ESDR150 - Rituximab in the treatment of pemphigus: A single-center Moroccan analysis of 43 cases

The guidelines in the management of pemphigus have evolved over the years to enhance treatments outcomes and prognosis. Rituximab (RTX) is today the first-line therapy for moderate to severe pemphigus.Objective to assess the response of RTX and to compare its efficacy as1stor2nd line treatment.We conducted a single-center retro-prospective study in the dermatology department of Ibn Sina university hospital of Rabat (2007-2021).43 patients were included,17 in the“naive”group and 26 in the“non-naive”group, 81% with severe initial PDAI score . The indications of RTX were relapse46.5%,severe30.2%,recalcitrant18.6% and moderate form4.7%.The mean duration of the consolidation phase was 5.9weeks,83.7% of patients were in complete remission(CR) at the 3rdmonth.80% were in CR under treatment at the 6th month and the mean time to CR was 5.05months.15%partial responders,42.5%good responders and 42.5%non-responders,the initial average dose of prednisone was 80mg and 24mg on the 6thmonth.The relapse rate was23.6% over a median period of16.27 months.60% of relapse cases had an initial CD4count<400cell/μl and 30% had a CD19count≥5 cell/μl on 6thmonth.The longest duration of relapse concerned the foliaceus and seborrheic phenotype 17months and 23.7months respectively and a cumulative dose of RTX greater than2.5g.No statistical difference(p>0.05)between the two groups concerning remission,relapse and the consolidation phase.All patients received 500mg infusion on the 6th month and 22patients received a maintenance treatment at 12,18 and 24months.side effects were noted at doses of 3g such as infusion-related reactions 9cases,2cases of bacterial pneumonia,1case of pneumocystis,1case of pericarditis,reactivation of HBV and 2cases of R-ILD.Our study is the largest national real life experience that has investigated the use of RTX in the treatment of pemphigus.Our results confirm the efficacy,the good tolerance of RTX as well as its significant role as a corticosteroid-sparing agent.