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While corticosteroid treatment is life saving, the high dose and prolonged courses required for disease control are associated with significant adverse effects, including death. Although introduction of rituximab (<jats:styled-content style=\"fixed-case\">RTX<\/jats:styled-content>) provided for a favorable outcome, the high relapse rate, that is, up to 80%, precludes successful use of <jats:styled-content style=\"fixed-case\">RTX<\/jats:styled-content> as a monotherapy. Intravenous immunoglobulin (<jats:styled-content style=\"fixed-case\">IVI<\/jats:styled-content>g) is being increasingly utilized as off\u2010label therapy for a variety of autoimmune and inflammatory diseases, including <jats:styled-content style=\"fixed-case\">PV<\/jats:styled-content> and pemphigus foliaceus (<jats:styled-content style=\"fixed-case\">PF<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The goal of pemphigus research is to develop an effective treatment modality that would allow patients to achieve and maintain a stable clinical remission without the need for additional treatments, or cure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This article summarizes clinical outcome of 123 pemphigus patients treated with a combination of <jats:styled-content style=\"fixed-case\">IVI<\/jats:styled-content>g, an immunosuppressive cytotoxic drug (<jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>) and mitochondrion\u2010protecting drugs in the Blistering Disease Clinic at the University of California, Irvine from 2007 to 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean time to disease control was 0.2 months and time to complete remission \u2013 1.7 months. Duration of complete remission on drugs until relapse or end of treatment was 19.3 months. The mean duration of complete remission off drugs until relapse was 15.8 months. That until end of follow up was 48.4 months, with a minimum of 14 and a maximum of 91 months. The overall complete remission rate off all drugs was 100%, with 12% overall relapse rate. Most relapses, 8.1 vs. 3.3%, occurred during the time of treatment, compared to posttreatment. No patients had more than a single relapse. The duration of the posttreatment follow\u2010up ranged from 9 to 97 months with a mean of 64.8 months, or 5.4 years. The total number of <jats:styled-content style=\"fixed-case\">IVI<\/jats:styled-content>g cycles ranged from 26 in patients without a relapse to 37 in patients with a relapse. The clinical outcome in patients that received <jats:styled-content style=\"fixed-case\">IVI<\/jats:styled-content>g with <jats:styled-content style=\"fixed-case\">RTX<\/jats:styled-content> or another <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content> were found to be very similar.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Thus, the multidrug <jats:styled-content style=\"fixed-case\">IVI<\/jats:styled-content>g regimen allowed to achieve three principal treatment objectives: (i) rapid control of pemphigus symptoms; (ii) stable disease remission; and (iii) overall safety of treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>While the individualized therapeutic approaches to eradicate the autoreactive B cell clones causing disease in each particular <jats:styled-content style=\"fixed-case\">PV<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">PF<\/jats:styled-content> patient are being developed, all pemphigus patients can benefit from the treatment protocol described in this study.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijd.14143","type":"journal-article","created":{"date-parts":[[2018,7,26]],"date-time":"2018-07-26T10:12:34Z","timestamp":1532599954000},"page":"114-125","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Retrospective analysis of a single\u2010center clinical experience toward development of curative treatment of 123 pemphigus patients with a long\u2010term follow\u2010up: efficacy and safety of the multidrug protocol combining intravenous immunoglobulin with the cytotoxic immunosuppressor and mitochondrion\u2010protecting drugs"],"prefix":"10.1111","volume":"58","author":[{"given":"Sergei A.","family":"Grando","sequence":"first","affiliation":[{"name":"Departments of Dermatology and Biological Chemistry and Institute for Immunology University of California Irvine CA 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