{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T02:33:44Z","timestamp":1788834824418,"version":"build-2803163510"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2022,6,25]],"date-time":"2022-06-25T00:00:00Z","timestamp":1656115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Various dosing protocols of rituximab have been used in pemphigus. B-cell repopulation following rituximab treatment can be considered a forerunner of clinical relapse. Immunologically guided dosing may remove the need for fixed timepoint maintenance dosing, hence being more cost-effective and perhaps safer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To compare the overall efficacy and cost-effectiveness of a low-dose rituximab regimen (500 mg, 2 weeks apart) with immunologically guided, ultralow-dose (200\u2009mg) top-up infusions on immunological relapse vs. the use of a rheumatoid arthritis (RA) protocol with rituximab 500\u2009mg repeat infusion to treat clinical relapse in severe pemphigus, over a 1-year period,<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In total, 23 patients with severe pemphigus were randomized into Group A (RA protocol: 1000\u2009mg given as two doses, 2\u2009weeks apart) and Group B (low-dose rituximab 500\u2009mg given as two doses, 2\u2009weeks apart). Both groups also received short-term oral corticosteroids, and underwent clinical and immunological (3-monthly flow cytometry assessments of B-cell subtypes) monitoring. Group A received a top-up dose of rituximab 500\u2009mg upon clinical relapse, while Group B received an ultralow top-up dose (200\u2009mg) following detection of B-cell repopulation, which was intended to prevent clinical relapse. Outcome parameters [complete remission off treatment (CROT), relapse (clinical and immunological), total corticosteroid dose and direct cost of therapy] were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean\u2009\u00b1\u2009SD time to CROT (Group A, 27.1\u2009\u00b1\u20091.6\u2009weeks; Group B, 26\u2009\u00b1\u20091.2\u2009weeks, P\u2009=\u20090.09) and the cumulative prednisolone dose (P\u2009=\u20090.28) were comparable between the two groups. In Group A, 3 of 9 (33.3%) patients had clinical relapse (mean\u2009\u00b1\u2009SD time of 9.3\u2009\u00b1\u20090.4\u2009months). In Group B, B-cell repopulation was seen in 10 of 11 (90.9%) patients within a mean time of 8.4\u2009\u00b1\u20092.4\u2009months, and a single top-up dose of 200\u2009mg successfully prevented clinical relapse. The overall cost of therapy was 37.4% cheaper in Group B.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An immunologically guided low-dose rituximab regimen can be an equally effective but more affordable alternative to conventional rituximab regimens in pemphigus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ced.15213","type":"journal-article","created":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T05:15:47Z","timestamp":1649135747000},"page":"1508-1516","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Comparison of the efficacy and cost-effectiveness of an immunologically targeted low-dose rituximab protocol with the conventional rheumatoid arthritis protocol in severe pemphigus"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9011-1833","authenticated-orcid":false,"given":"Namrata","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1486-7161","authenticated-orcid":false,"given":"Sanjeev","family":"Handa","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4320-3193","authenticated-orcid":false,"given":"Rahul","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naresh","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Department of Endocrinology (Immunology Division) Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8682-2598","authenticated-orcid":false,"given":"Dipankar","family":"De","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,1]]},"reference":[{"key":"2023041114210378300_","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.beha.2011.02.009","article-title":"Rituximab resistance","volume":"24","author":"Rezvani","year":"2011","journal-title":"Best Pract Res 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