{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:16:22Z","timestamp":1791994582354,"version":"4.4.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec id=\"ab-doi240072-4\"><jats:title>Importance<\/jats:title><jats:p>Rituximab is approved for the treatment of moderate to severe pemphigus. However, 20% of patients in the RITUX 3 trial relapsed within the first year of treatment.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240072-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the outcome of an additional rituximab infusion at month 6 in patients with pemphigus who were in complete remission (CR) after rituximab regimen but had 1 or more predictors of relapse at month 3.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240072-6\"><jats:title>Design, Settings, and Participants<\/jats:title><jats:p>This multicenter cohort study was conducted in France from September 2018 to June 2023 to assess patients with newly diagnosed pemphigus who were in CR after treatment with the RITUX 3 regimen but had predictors of relapse at month 3. Relapse factors were a Pemphigus Disease Area Index (PDAI) score of 45 or higher, desmoglein 1 (DSG1) antibodies greater than 20 IU\/mL, and\/or DSG3 antibodies greater than 130 IU\/mL.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240072-7\"><jats:title>Exposure<\/jats:title><jats:p>Patients in CR at month 6 with at least 1 predictor of relapse were treated with an additional rituximab infusion at month 6.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240072-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Primary end point was the rate of CR without corticosteroid therapy for 2 months at month 12. Secondary end points were the rate of relapse, number of patients needing to be re-treated (NNT) with rituximab to avoid a relapse, and safety.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240072-9\"><jats:title>Results<\/jats:title><jats:p>The study population comprised 87 patients (44 females [50.6%] and 43 [49.4%] males), with a mean (SD [range]) age of 55.3 (15.2 [24-92]) years at pemphigus diagnosis. Of these, 64 patients (73.6%) had pemphigus vulgaris and 23 (26.4%) had pemphigus foliaceus. At month 6, CR had been achieved by 77 patients (88.5%), and 10 (11.5%) had persistent disease activity. Of the 77 patients in CR, 30 (39.0%) had at least 1 predictor of relapse and received an additional infusion of rituximab; 47 patients (61.0%) without a predictor did not. Two patients without a predictor and no patients with a predictor experienced relapse\u2014an overall relapse rate of 2.6% and an NNT of 3.6 (95% CI, 1.6-46.5). The 10 patients (11.5%) with persistent disease activity at month 6 were re-treated with rituximab, 2000 mg. At month 12, the rate of CR without corticosteroid therapy for a minimum of 2 months was 72 of 77 (93.5%) among patients who had achieved CR at month 6, and 72 of 87 (82.7%) for the whole study population. Eight serious adverse effects were reported among 5 patients; there were no deaths.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240072-10\"><jats:title>Conclusion and Relevance<\/jats:title><jats:p>This multicenter cohort study indicates that using predictors such as baseline PDAI score, anti-DSG1 antibodies, and\/or anti-DSG3 antibodies to initiate preemptive treatment with additional rituximab may reduce the rate of short-term relapse.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2024.6130","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T16:00:39Z","timestamp":1738771239000},"page":"399","source":"Crossref","is-referenced-by-count":14,"title":["Optimizing Pemphigus Management With Rituximab and Short-Term Relapse Predictors"],"prefix":"10.1001","volume":"161","author":[{"given":"Vivien","family":"H\u00e9bert","sequence":"first","affiliation":[{"name":"Department of Dermatology, Centre Hospitalier Universitaire de Rouen and Institut National 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France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Pham-Ledard","sequence":"additional","affiliation":[{"name":"Dermatology Department, Centre Hospitalier Universitaire Bordeaux and INSERM U1312, Bordeaux Institute of Oncology, Translational Research on Oncodermatology and Rare Skin Diseases, Bordeaux University, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Caux","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Centre de R\u00e9f\u00e9rence des Maladies Bulleuses Auto-immunes, Avicenne Hospital, Assistance Publique-H\u00f4pitaux de Paris, University of Paris, Bobigny, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Billal","family":"Tedbirt","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Centre Hospitalier Universitaire de Rouen and Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale 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