A retrospective cohort study of biosimilar rituximab therapy in pemphigus: experience from a tertiary care hospital in North India

Introduction:
Biosimilar rituximab (RTX) has been increasingly used in the treatment of pemphigus. There is limited data of its use in Indian pemphigus patients.

Objective:
To retrospectively study the safety and efficacy of biosimilar rituximab in pemphigus management.

Results:
A total of 20 pemphigus patients received RTX therapy of which four were excluded due to incomplete records. There were 4 (25%) males and 12 (75%) females with a mean age of 34.81 ±1.87 years. The average duration of disease before RTX administration was 12.68 ±13.31 months. There were 13 (81.25%) patients of pemphigus vulgaris, 2 (12.5%) of mucosal pemphigus vulgaris and 1 (6.5%) of pemphigus foliaceus. Majority of the patients were shifted from other treatments to biosimilar rituximab therapy with only three treatment-naïve cases. All patients received the rheumatoid arthritis protocol. The average duration of follow up after RTX infusion was 16.25 ±10.91 months. Six (37.5%) patients achieved complete remission off therapy, 6 (37.5%) complete remission on therapy and 4 (25%) partial remission on minimal therapy. Only one patient developed relapse after 18 months of biosimilar rituximab therapy.

Conclusions:
Biosimilar rituximab therapy is safe and effective in the management of pemphigus. It provides long periods of remission without the adverse effects associated with conventional treatment of glucocorticosteroid and oral immunosuppressant therapy.