Efficacy and Safety of Rituximab in Immunobullous Diseases: A Retrospective Study from a Tertiary Care Centre of NepalCorrespondence Address :
Associate Professor, Department of Dermatology and Venereology,
Maharajgunj Medical Campus, Institute of Medicine, Nepal.
Introduction: Rituximab is effective and safe treatment of immunobullous disorders. There are variations in doses of drugs used in different studies and uncertainties on when to use it along with use of adjuvant therapies. Efficacy and safety of this drug has not been described in Nepalese population till date. Dermatologists have hesitation in starting this drug in immunobullous diseases because of lack of data on efficacy and safety.
Aim: To assess the efficacy and side effects of Rituximab therapy in treating immunobullous disorders in Nepalese patients.
Materials and Methods: This was a retrospective study of patients with immunobullous diseases treated with Rituximab in Dermatological ward of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from May 2018 to August 2019. Data were analysed for duration of disease and treatment received before Rituximab therapy, duration of steroid used before Rituximab, adverse effects due to prolonged steroid use, time to remission from 1st Rituximab pulse, duration of remission, relapse, duration of steroid and adjuvant drug used post 1st pulse and adverse effects associated with Rituximab. SPSS version 20 was used for data entry and descriptive statistics was used for analysis of the data.
Results: Nine patients (Pemphigus Vulgaris-8 (PV-8), Bullous Pemphigoid-1 (BP-1) were treated with Rituximab. Seven were treated for refractory disease not controlled by conventional therapy and two received Rituximab as first-line therapy. The patients were under follow-up for 15-60 weeks (mean 31.89±15.62 weeks). Out of these nine patients, eight were free of lesions in one to eight weeks (mean 5.125±2 weeks) of first pulse. One patient with Oral Pemphigus had persistence of old lesions, however there were no new cutaneous lesions after first pulse. Adverse effects were seen in four patients that included infusion reaction in one and infection in three. There was relapse in one patient at last follow-up.
Conclusion: Rituximab is efficacious and is safe in treating immunobullous disorders in Nepalese Population..
Azathioprine, Bullous pemphigoid, Cyclophosphamide, Pemphigus, Steroids
Date of Submission: Dec 18, 2019
Date of Peer Review: Apr 30, 2020
Date of Acceptance: Jul 13, 2020
Date of Publishing: Sep 01, 2020
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
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• Plagiarism X-checker: Dec 21, 2019
• Manual Googling: Jul 02, 2020
• iThenticate Software: Aug 10, 2020 (9%)
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