| Autor: |
Popa LG; Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania.; Department of Dermatology, Elias Emergency University Hospital, 17 Marasti Bd., District 1, 011461 Bucharest, Romania., Dumitras I; Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania., Giurcaneanu C; Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania.; Department of Dermatology, Elias Emergency University Hospital, 17 Marasti Bd., District 1, 011461 Bucharest, Romania., Berghi O; Department of Allergy and Clinical Immunology, Colentina Clinical Hospital, 19-21 Stefan cel Mare Bd., District 2, 020125 Bucharest, Romania., Radaschin DS; Department of Dermatology, Dunarea de Jos University of Medicine and Pharmacy, 25 Otelarilor Bd., 800008 Galati, Romania., Vivisenco CI; Department of Paediatrics, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania.; Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania., Popescu MN; Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania.; Department of Physical and Rehabilitation Medicine, Dermatology Department, Elias Emergency University Hospital, 17 Marasti Bd., District 1, 011461 Bucharest, Romania., Beiu C; Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania.; Department of Dermatology, Elias Emergency University Hospital, 17 Marasti Bd., District 1, 011461 Bucharest, Romania. |
| Abstrakt: |
Autoimmune blistering diseases represent a group of chronic severe, disabling, and potentially fatal disorders of the skin and/or mucous membranes, primarily mediated by pathogenic auto-antibodies. Despite their rarity, these diseases are associated with significant morbidity and mortality and profound negative impact on the patient's quality of life and impose a considerable economic burden. Rituximab, an anti-CD-20 monoclonal antibody, represents the first line of therapy for pemphigus, regardless of severity and a valuable off-label therapeutic alternative for subepidermal autoimmune blistering diseases as it ensures high rates of rapid, long-lasting complete remission. Nevertheless, disease recurrence is the rule, all patients requiring maintenance therapy with rituximab eventually. While innate resistance to rituximab in pemphigus patients is exceptional, acquired resistance is frequent and may develop even in patients with initial complete response to rituximab, representing a real challenge for physicians. We discuss the various resistance mechanisms and their complex interplay, as well as the numerous therapeutic alternatives that may be used to circumvent rituximab resistance. As no therapeutic measure is universally efficient, individualization of rituximab treatment regimen and tailored adjuvant therapies in refractory autoimmune blistering diseases are mandatory. |
