{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:23:27Z","timestamp":1786987407584,"version":"build-2736575974"},"reference-count":19,"publisher":"Scientific Scholar","content-domain":{"domain":["ijdvl.com"],"crossmark-restriction":true},"short-container-title":["Indian J Dermatol Venereol Leprol"],"abstract":"\n Background<\/jats:title>\n Pemphigus relapse after rituximab treatment remains a challenge.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n To correlate the changing trends of immunological biomarkers with timing of pemphigus relapse, and identify its predictors following rituximab treatment<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This prospective cohort study included 44 patients with pemphigus treated with a rituximab biosimilar (rheumatoid arthritis protocol). Clinical data were recorded at baseline, and immunological biomarkers (anti-DSG1, anti-DSG3, anti-AChRM3, CD19\n +<\/jats:sup>\n B-cells, CD19\n +<\/jats:sup>\n 27\n +<\/jats:sup>\n memory B-cells) were estimated at baseline and every three\u00a0months till 12 months. Patients were clinically followed-up for 2 years or until relapse and grouped as early (<12 months) relapse, relapsing between 12-24 months, and no relapse till 24 months.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Twenty-four (54.5%) patients relapsed by 2 years, with 18 (75%) relapsing within the first year. Early (3-6 months) rise in CD19\n +<\/jats:sup>\n B-cells, anti-DSG3 and anti-DSG1 levels, and delayed (9-12 months) anti-DSG3 rise distinguished early from late relapse, while patients remaining relapse-free exhibited no significant immunological changes. At month 6, 73.3% of early relapsing patients had anti-DSG3 >120 RU\/mL, as compared to 27.3% of patients without early relapse (p=0.008). Early relapse rates were significantly higher in patients with incomplete B-cell depletion at 3 months (100% vs 35%; p=0.02). There was no significant difference in the relapse rates based on B-cell repopulation (p=0.20). Incomplete B-cell depletion at 3 months and\/or anti-DSG3 >120 RU\/mL at 6 months had a positive and negative predictive value of 64.7% and 87.5% respectively, for early relapse.\n <\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n Relatively small and heterogeneous sample, including both pemphigus vulgaris and foliaceus, as well as treatment-na\u00efve and relapsed patients<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Patients with incomplete B-cell depletion and\/or rising anti-DSG3 are at risk for early relapse and may benefit from closer monitoring or a maintenance rituximab infusion at 6 months.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/ijdvl_704_2025","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T07:08:11Z","timestamp":1754896091000},"page":"443-450","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Longitudinal trends in immunological biomarkers, and predictors of relapse in pemphigus treated with rituximab: A prospective cohort study"],"prefix":"10.25259","volume":"92","author":[{"given":"Rhea","family":"Ahuja","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shafaque","family":"Imran","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj K","family":"Tembhre","sequence":"additional","affiliation":[{"name":"Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh K","family":"Vishwanathan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, All India Institute of Medical 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