利妥昔单抗治疗口腔黏膜天疱疮的临床应用进展

doi:10.12337/zgkqjxjyzz.2024.03.002

中国口腔医学继续教育杂志 ›› 2024, Vol. 27 ›› Issue (3): 200-205.DOI: 10.12337/zgkqjxjyzz.2024.03.002

利妥昔单抗治疗口腔黏膜天疱疮的临床应用进展

程喆, 王倩, 刘佳, 童萍, 金建秋^*

北京医院口腔科,国家老年医学中心,中国医学科学院老年医学研究院

出版日期:2024-05-31 发布日期:2024-12-18
通讯作者: ^*金建秋,联系方式：010-85133402,电子邮箱:jianqiu_82@126.com,通讯地址：北京市东城区东单大华路1号,100730
基金资助:
国家重点研发计划资助（项目编号：2023YFC3605603）; 北京卫健委住院医师规范化培训质量提高项目（项目编号：住培2023039）

Clinical Application of Rituximab in the Treatment of Oral Pemphigus

Zhe Cheng, Qian Wang, Jia Liu, Ping Tong, Jianqiu Jin^*

Department of Stomatology, Beijing Hospital, Institute of Geriatrics, Chinese Academy of Medical Sciences, Beijing, P.R. China

Online:2024-05-31 Published:2024-12-18
Contact: Jianqiu Jin. Tel: 010-85133402. Email: jianqiu_82@126.com. Address: Dongdan Dahua Road, Dongcheng District, Beijing 100730, P.R.China.
Supported by:
National Key R&D Program of China（No.2023 YFC3605600）, Beijing Health Commission Resident Physician Standardization Training Quality Improvement Project（No.Residential Training 2023039）

摘要/Abstract

摘要： 天疱疮是一种严重的慢性自身免疫性大疱类疾病,其病程迁延反复,治疗难度较大,可能导致患者死亡。长久以来,糖皮质激素是天疱疮的主流治疗方案,极大降低了死亡率,并使80% 以上的患者获得了好的疗效。利妥昔单抗虽面世较晚,但因其疗效出众、不良反应较小,在临床上逐渐得到了更多的应用,适用于对激素禁忌或效果较差、不良反应较大的天疱疮患者。本文总结了利妥昔单抗治疗天疱疮的适应证、治疗方案、疗效、不良反应。

关键词: 口腔黏膜天疱疮, 利妥昔单抗, 治疗方法, 不良反应, 老年患者

Abstract: Pemphigus is a serious chronic autoimmune bullous disease, with a prolonged and repeated course, making it difficult to treat and it may lead to death. For a long time, glucocorticoids have been the mainstream treatment for pemphigus vulgaris, greatly reducing mortality rates and achieving good therapeutic effects in over 80% of patients. Although rituximab was introduced relatively late, it has gradually gained more application in clinical practice due to its outstanding efficacy and minimal adverse reactions. It is suitable for patients with pemphigus vulgaris who are contraindicated to hormones or have poor efficacy and significant adverse reactions. This article summarizes the indications, treatment plans, efficacy, and adverse reactions of rituximab in the treatment of pemphigus vulgaris.

Key words: oral pemphigus, rituximab, treatment, side effects, elderly patients

程喆, 王倩, 刘佳, 童萍, 金建秋. 利妥昔单抗治疗口腔黏膜天疱疮的临床应用进展[J]. 中国口腔医学继续教育杂志, 2024, 27(3): 200-205.

Zhe Cheng, Qian Wang, Jia Liu, Ping Tong, Jianqiu Jin. Clinical Application of Rituximab in the Treatment of Oral Pemphigus[J]. Chinese Journal of Stomatological Continuing Education, 2024, 27(3): 200-205.

参考文献

[1] 华红, 刘宏伟. 口腔黏膜病学[M].北京大学医学出版社, 2014.
[2] Vodo D, Sarig O, Sprecher E.The Genetics of Pemphigus Vulgaris[J]. Front Med(Lausanne). 2018; 14(5):226.
[3] Popescu I, Statescu L, Vata D, et al.Pemphigus vulgaris-approach and management (Review)[J]. Exp Ther Med. 2019; 18:5056-5060.
[4] Schmidt E, Kasperkiewicz M, Joly P.Pemphigus[J]. Lancet. 2019; 394(10201): 882-894.
[5] Giannetti L, Generali L, Bertoldi C.Oral pemphigus[J]. G Ital Dermatol Venereol. 2018; 153(3):383-388.
[6] Schmitt T, Hudemann C, Moztarzadeh S, et al.Dsg3 epitope-specific signalling in pemphigus[J]. Front Immunol. 2023; 18(14):1163066.
[7] Pradeep A, Eapen M, Jagadeeshan S, et al.Correlation of desmoglein 1 and 3 immunohistochemistry with autoantibody levels and clinical severity in pemphigus[J]. J Cutan Pathol. 2023; 50(12):1104-1109.
[8] Pan Q, Zhang Y, Gao F.Pathogenesis of pemphigus[J] Int J Dermatol Venereol. 2017; 43(5):301-304.
[9] 王明悦, 高昱, 彭洋, 等. 糖皮质激素治愈寻常型天疱疮患者临床分析[J]. 临床皮肤科杂志, 2015, 44(11): 679-681.
[10] Porro AM, Seque CA, Ferreira MC C, et al.Pemphigus vulgaris[J]. Anais Brasileiros de Dermatologia. 2019; 94(3):264-278.
[11] Schmidt E, Sticherling M, Sárdy M, et al.S2k guidelines for the treatment of pemphigus vulgaris/foliaceus and bullous pemphigoid: 2019 update[J]. J Dtsch Dermatol Ges. 2020; 18(5):516-527.
[12] Harman KE, Brown D, Exton LS, et al.British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 2017[J]. Br J Dermatol. 2017; 177(5):1170-1201.
[13] Hertl M, Jedlickova H, Karpati S, et al.Pemphigus. S2 Guideline for diagnosis and treatment-guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV)[J]. J Eur Acad Dermatol Venereol. 2015; 29(3):405-414.
[14] Huang A, Madan RK, Levitt J.Future therapies for pemphigus vulgaris: Rituximab and beyond[J]. J Am Acad Dermatol. 2016; 74(4):746-753.
[15] Kridin K, Ahmed AR.The evolving role of rituximab in the treatment of pemphigus vulgaris: a comprehensive state-of-the-art review[J]. Expert Opin Biol Ther. 2021; 21(4):443-454.
[16] Perifani V, Dalamaga M, Theodoropoulos K, et al.Real world evidence: Patients with refractory pemphigus treated with Rituximab[J]. Metabolism Open. 2021; 12: 100142.
[17] Bomm L, Fracaroli TS, Sodré JL, et al.Off-label use of rituximab in dermatology: pemphigus treatment[J]. An Bras Dermatol. 2013; 88(4):676-678.
[18] Zakka LR, Shetty SS, Ahmed AR.Rituximab in the Treatment of Pemphigus Vulgaris[J]. Dermatol Ther (Heidelb). 2012; 2(1):17.
[19] El-Zawahry B, Bassiouny D, Hegazy R, et al.Rituximab treatment in pemphigus vulgaris: effect on circulating Tregs[J]. Arch Dermatol Res. 2017; 309(7):551-556.
[20] Porro AM, Hans Filho G, Santi CG.Consensus on the treatment of autoimmune bullous dermatoses: pemphigus vulgaris and pemphigus foliaceus-Brazilian Society of Dermatology[J]. An Bras Dermatol. 2019; 94(2 Suppl 1):20-32.
[21] Goldberg IM, Brooks J, Ghita I, et al.Oral and cutaneous pemphigus vulgaris: an atypical clinical presentation.[J]. Gen Dent. 2022; 70(6):22-26.
[22] Fortuna G, Calabria E, Aria M, et al.Immunocytometric Analysis of Oral Pemphigus vulgaris Patients after Treatment with Rituximab as Adjuvant[J]. Biomolecules. 2021; 11(11):1634.
[23] Vinay K, Kanwar AJ, Mittal A, et al.Intralesional Rituximab in the Treatment of Refractory Oral Pemphigus Vulgaris[J]. JAMA Dermatol. 2015; 151(8): 878-882.
[24] Joly P, Mouquet H, Roujeau J-C, et al.A Single Cycle of Rituximab for the Treatment of Severe Pemphigus[J]. N Engl J Med. 2007; 357(6):545-552.
[25] Lunardon L, Tsai KJ, Propert KJ, et al.Adjuvant Rituximab Therapy of Pemphigus: a single-center experience with 31 patients[J]. Arch Dermatol. 2012; 148(9):1031-11036.
[26] Morrison LH.Therapy of refractory pemphigus vulgaris with monoclonal anti-CD20 antibody (rituximab)[J]. J Am Acad Dermatol. 2004; 51(5):817-819.
[27] Cianchini G, Corona R, Frezzolini A, et al.Treatment of Severe Pemphigus With Rituximab[J]. Arch Dermatol. 2007; 143(8):1033-1038.
[28] Fortuna G, Calabria E, Ruoppo E, et al.The use of rituximab as an adjuvant in the treatment of oral pemphigus vulgaris[J]. J Oral Pathol Med. 2020; 49(1):91-95.
[29] Kanokrungsee S, Anuntrangsee T, Tankunakorn J, et al.Rituximab Therapy for Treatment of Pemphigus in Southeast Asians[J]. Drug Des Devel Ther. 2021; 15:1677-1690.
[30] Nosrati A, Hodak E, Mimouni T, et al.Treatment of Pemphigus with Rituximab: Real-Life Experience in a Cohort of 117 Patients in Israel[J]. Dermatology. 2021; 237(3):450-456.
[31] Bozca BC, Bilgiç A, Uzun S.Long-term experience with rituximab therapy for treatment-resistant moderate-to-severe pemphigus[J]. J Dermatolog Treat. 2022; 33(4):2102-2109.
[32] Shah BJ, Mistry D, Shah SR.Long-term efficacy and safety analysis of single cycle of biosimilar rituximab in pemphigus: A retrospective study of 76 patients from India[J]. Dermatol Ther. 2022; 35(9):e15704.
[33] Yamagami J, Kurihara Y, Funakoshi T, et al.Rituximab therapy for intractable pemphigus: A multicenter, open-label, single-arm, prospective study of 20 Japanese patients[J]. J Dermatol. 2023; 50(2):175-182.
[34] Mignard C, Maho-Vaillant M, Golinski M-L, et al.Factors Associated With Short-term Relapse in Patients With Pemphigus Who Receive Rituximab as First-line Therapy[J]. JAMA Dermatol. 2020; 156(5):545-552.
[35] 刘静, 刘娜, 王伟, 等. 利妥昔单抗治疗19例天疱疮的护理体会[J]. 中国麻风皮肤病杂志, 2023, 39(8): 611-613.
[36] 李晔, 何黎, 曹灿, 等. 利妥昔单抗联合糖皮质激素治疗2例难治性天疱疮临床观察[J]. 皮肤病与性病, 2021, 43(6):756-758, 763.
[37] Robinson AJ, Vu M, Unglik GA, et al.Low-dose rituximab and concurrent adjuvant therapy for pemphigus: Protocol and single-centre long-term review of nine patients[J]. Australas J Dermatol. 2018; 59(1): e47-e52.
[38] 苟辉, 项红梅, 詹同英, 等. 低剂量利妥昔单抗治疗51例天疱疮患者的护理[J]. 中国麻风皮肤病杂志, 2022, 38(4):253-255.
[39] Kimby E.Tolerability and safety of rituximab (MabThera^®)[J]. Cancer Treat Rev. 2005; 31(6):456-473.
[40] Faraji H, Daneshpazhooh M, Ehsani AH, et al.Evaluating the risk-to-benefit ratio of using cotrimoxazole as a pneumocystis pneumonia preventative intervention among pemphigus patients treated with rituximab: A retrospective study with 494 patients[J]. Dermatol Ther. 2022; 35(2):e15257.
[41] Neema S, Vendhan S, Vasudevan B, et al.Rituximab-induced new onset palmo-plantar pustulosis in patients with pemphigus foliaceus: A rare adverse effect[J]. Dermatol Ther. 2022; 35(9):e15714.
[42] Shahrigharahkoshan S, Dadkhahfar S, Mozafari N, et al.A review of reported infectious events following rituximab therapy in pemphigus patients[J]. Dermatol Ther. 2022; 35(3):e15264.
[43] Kridin K, Mruwat N, Ludwig RJ.Association of Rituximab With Risk of Long-term Cardiovascular and Metabolic Outcomes in Patients With Pemphigus[J]. JAMA Dermatol. 2023; 159(1):56-61.
[44] Karan A, Kiamos A, Reddy P.Thrombotic Storm Induced by Rituximab in a Patient With Pemphigus Vulgaris[J]. Cureus. 2023; 15(2):e35469.
[45] Tedbirt B, Maho-Vaillant M, Houivet E, et al.Sustained Remission Without Corticosteroids Among Patients With Pemphigus Who Had Rituximab as First-Line Therapy:Follow-Up of the Ritux 3 Trial[J]. JAMA Dermatol. 2024; 160(3):290-296.
[46] Murrell DF, Peña S, Joly P, et al. Diagnosis and management of pemphigus: Recommendations of an international panel of experts[J]. J Am Acad Dermatol.2020; 82(3):575-585.e1.
[47] Kraft M, Worm M.Pemphigus Foliaceus—Repeated Treatment With Rituximab 7 Years After Initial Response: A Case Report[J]. Front Med (Lausanne). 2018; 5:315.
[48] Tej S, Undrajavarapu A, Kadian K, et al.Rituximab-Induced Interstitial Lung Disease: A Stitch in Time Saved Nine[J]. Cureus. 2022; 14(7):e27088.
[49] Awdeh F, Gilhooley E, O Grady C, et al. Refractory pemphigus foliaceous treated with rituximab[J]. BMJ Case Rep. 2019; 12(5):e229026.

利妥昔单抗治疗口腔黏膜天疱疮的临床应用进展

Clinical Application of Rituximab in the Treatment of Oral Pemphigus

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