Clinical and immunological predictors of post-rituximab paradoxical pemphigus flare: A prospective cohort study

Simple item page
dc.contributor.authorGupta, Ven_US
dc.contributor.authorAhuja, Ren_US
dc.contributor.authorSindhuja, Ten_US
dc.contributor.authorImran, Sen_US
dc.contributor.authorViswanathan, GKen_US
dc.contributor.authorTembhre, MKen_US
dc.contributor.authorPandey, Sen_US
dc.contributor.authorKhandpur, S.en_US
dc.date.accessioned2025-06-18T11:42:20Z
dc.date.available2025-06-18T11:42:20Z
dc.date.issued2025-02
dc.description.abstractBackground: Paradoxical flare of pemphigus following rituximab infusion has been reported previously, however, its inci- dence or risk factors have not been studied in detail. Objectives: To evaluate the clinical and immunological predictors associated with post-rituximab paradoxical pemphigus flare. Materials and Methods: This was a prospective cohort study including adult patients with pemphigus vulgaris or foliaceus who were treated with rituximab. Patients were administered 1000 mg of intravenous rituximab on days 0 and 14 (Rheumatoid arthritis (RA) protocol), with or without oral prednisolone and/or conventional immunosuppressive agents. Baseline clinical and immunological predictors of post-rituximab pemphigus flares were assessed. Results: Fifty patients (mean age 40.44 ± 12.36 years) with a mean pemphigus disease area index (PDAI) score of 27.8 ± 15.48 were administered rituximab. Post-rituximab flare occurred in 10 (20%) patients after a mean of 14.1 ± 4.33 days after the first rituximab infusion. The mean baseline PDAI score (36.4 ± 11.7 vs. 25.6 ± 15.7, P = 0.02) and serum anti-Dsg1 levels (1216.8 ± 850.1 vs. 592 ± 562.12 RU/mL, P = 0.03) were statistically significantly higher in patients experiencing a flare. Using ROC- curve analysis, a PDAI score of ?28 (OR 8.3, 95% CI 1.5–44.7) was 80% sensitive and 67.5% specific in predicting post- rituximab flare, while serum anti-Dsg1 level of >1137.78 RU/ml had a sensitivity of 60% and specificity of 85%. There was no significant difference in terms of affected body surface area, type of pemphigus, starting prednisolone dose, oral immunosuppressive adjuvant, serum anti-Dsg3, serum anti-AchRM3, and peripheral CD19+ B cell population. Limitations: Our study is limited by a relatively small sample size. Immunological factors were not evaluated at the time of pemphigus flare. Though these unexpected pemphigus flares are likely to be associated with rituximab infusion, the possibility of spontaneous disease exacerbation cannot be entirely excluded. Conclusions: Patients with more severe pemphigus or high serum anti-Dsg1 are at risk of post-rituximab paradoxical flare, and may benefit from rituximab administration under close monitoring.en_US
dc.identifier.affiliationsDepartment of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Indiaen_US
dc.identifier.affiliationsDepartment of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Indiaen_US
dc.identifier.affiliationsDepartment of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Indiaen_US
dc.identifier.affiliationsDepartment of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Indiaen_US
dc.identifier.affiliationsDepartment of Hematology, All India Institute of Medical Sciences, New Delhi, Indiaen_US
dc.identifier.affiliationsDepartment of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, Indiaen_US
dc.identifier.affiliationsDepartment of Biostatistics, All India Institute of Medical Sciences, New Delhi, Indiaen_US
dc.identifier.affiliationsDepartment of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Indiaen_US
dc.identifier.citationGupta V, Ahuja R, Sindhuja T, Imran S, Viswanathan GK, Tembhre MK, Pandey S, Khandpur S. . Clinical and immunological predictors of post-rituximab paradoxical pemphigus flare: A prospective cohort study. Indian Journal of Dermatology, Venereology and Leprology. 2025 Feb; 91(1): 3-8en_US
dc.identifier.issn0378-6323
dc.identifier.issn0973-3922
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/249382
dc.languageenen_US
dc.publisherScientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India.en_US
dc.relation.issuenumber1en_US
dc.relation.volume91en_US
dc.source.urihttps://dx.doi.org/10.25259/IJDVL_894_2023en_US
dc.subjectpemphigusen_US
dc.subjectparadoxical flareen_US
dc.subjectrituximaben_US
dc.subjectPDAIen_US
dc.subjectpredictorsen_US
dc.titleClinical and immunological predictors of post-rituximab paradoxical pemphigus flare: A prospective cohort studyen_US
dc.typeJournal Articleen_US
Files
Original bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
ijdvl2025v91n1p3.pdf
Size:
530.22 KB
Format:
Adobe Portable Document Format
Download
Collections
Indian Journal of Dermatology, Venereology and Leprology