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Pemphigus Vulgaris — SCE Dermatology MCQ

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ModerateBlistering DiseasesPemphigus VulgarisSCE Dermatology

A 45-year-old man with pemphigus vulgaris has achieved complete remission on Rituximab. He asks whether he will need treatment indefinitely. What is the typical Rituximab maintenance strategy in pemphigus?

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Correct answer: E — Rituximab maintenance infusions (typically every 6 months initially then extended based on anti-Dsg titres and clinical status)

Rituximab maintenance in pemphigus typically involves scheduled re-infusions (commonly 500 mg-1000 mg every 6 months initially) with interval extension guided by anti-desmoglein antibody titres and clinical status. The RITUX 3 trial used a maintenance protocol with scheduled infusions at months 12 and 18. Some centres use a 'treat-to-target' approach, re-treating when anti-Dsg titres rise or B-cells return. Complete and sustained remission off all therapy is achievable in some patients but many require ongoing maintenance. Long-term B-cell depletion necessitates monitoring for hypogammaglobulinaemia, infection risk, and vaccination planning (live vaccines contraindicated for 6-12 months after last dose).

Reference: BAD 2017 Pemphigus Guidelines; RITUX 3 Protocol