Rituximab/immunoglobulin combination shows promise in recalcitrant ocular cicatricial pemphigoid

This retrospective study included 12 patients with recalcitrant ocular cicatricial pemphigoid treated with rituximab and intravenous immunoglobulin (six patients) or more aggressive immunosuppressive therapy (six patients) after failing initial systemic immunosuppressive therapy. Ten of the patients were unilaterally blind after initial treatment.

At a median follow-up of 11 months, BCVA remained stable in the combination group and no further progression was observed. All six patients in the control group progressed and became blind in their second eye.

The authors emphasize that indications for the rituximab-immunoglobulin combination are few and include complete failure of conventional immunosuppressive therapy, significant side effects that limit their continued use, continuous and progressive conjunctival inflammation despite aggressive conventional immunosuppressive therapy, imminent threat of blindness, onset of blindness in one eye despite aggressive conventional immunosuppressive therapy and poor or no response to intravenous immunoglobulin monotherapy over the course of a year.

The main concern with using rituximab to treat autoimmune diseases, especially with concomitant immunosuppressive therapy, is the high incidence of systemic infections, which can sometimes lead to fatal septicemia. In this study, no deaths or infections occurred in patients treated with rituximab.