A patient with refractory pemphigus vulgaris is considered for rituximab. The recommended dose used in pemphigus is based on which protocol, and what is the target cell?
- A Lymphoma protocol (375 mg/m² × 4 weekly doses); CD20+ B cells
- B Both protocols have been used; CD20+ B cells ✓
- C Rheumatoid arthritis protocol (1000 mg × 2, 2 weeks apart); CD20+ B cells
- D Lymphoma protocol; CD4+ T helper cells
Correct answer: B. Both protocols have been used; CD20+ B cells
Explanation
Rituximab (anti-CD20 monoclonal antibody) depletes CD20-positive B cells, thereby reducing pathogenic anti-Dsg IgG. Both the lymphoma protocol (375 mg/m² weekly × 4) and the RA protocol (1000 mg × 2 infusions, 2 weeks apart) have been used in pemphigus with comparable efficacy; current consensus guidelines (including the 2020 EDF guidelines) support both regimens. Rituximab is now considered a first-line steroid-sparing agent for moderate-to-severe pemphigus by many authorities.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
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