Pemphigus

TREATMENT​

Rituximab

Predicting Relapse

Optimizing Pemphigus Management With Rituximab and Short-Term Relapse Predictors. JAMA Dermatol. 2025. Erratum in: JAMA Dermatol. 2025. PMID: 39908046.

• Factors at Month 3 predicting relapse at month 12:

  • Pemphigus Disease Area Index (PDAI) ≥ 45

  • Anti-desmoglein 1 > 20 IU/mL

  • Anti-desmoglein 3 > 130 IU/mL

• Treatment algorithm based on this study :​

  • Step 1: Assess Remission Status at Month 6

    • NOT in complete remission (CR): Re-treat with full induction dose (rituximab 2000 mg), restores control in ~80% of cases

    • IN complete remission: Proceed to Step 2

  • Step 2: Review Month 3 Relapse Predictors. Any of the following = High Risk of Relapse

    • Yes → High Risk: Re-dose at Month 6, start with 500 mg, increase to 1000 mg if patient had very severe disease (e.g., PDAI >60) or still has high DSG antibody titers at month 6, or body weight >90 kg or comorbidities needing extra immunosuppressive coverage

    • No → Low Risk: just monitor, re-treat only if relapse occurs or antibody levels rise

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