Ofatumumab subcutaneous injection promising treatment option for refractory pemphigus vulgaris: Study

Wei Li, Sichuan University, Chengdu, China, and colleagues reported outcomes in three pemphigus vulgaris patients who experienced a relapse after rituximab therapy and received treatment of ofatumumab subcutaneous injections (at baseline and week 2) combined with low-dose glucocorticoids. Overall, two patients achieved lesion clearance, and one patient showed significant improvement. No serious adverse events were reported.

Pemphigus is a rare group of autoimmune diseases that causes blisters on the mucous membranes and skin throughout the body. It can affect the nose, mouth, eyes, throat, and genitals. The most common type of pemphigus is Pemphigus vulgaris.

The therapeutic strategy for pemphigus vulgaris treatment still needs optimization because of the multiple deficiencies of rituximab and glucocorticoid. A recent retrospective study revealed that the recurrence rate of PV after a single-cycle infusion of rituximab was 63%. Ofatumumab is a subcutaneous anti-CD20 monoclonal antibody administered subcutaneously and provides a possible alternative option.

In the study, three patients experienced a relapse of pemphigus vulgaris after clinical remission induced by rituximab. They received an ofatumumab (20 mg) subcutaneous injection twice (2 weeks apart) in combination with a prednisone dose adjusted according to their disease severity and weight, with written informed consent.

The following were the key findings of the study:

• Over the 24-week observation, two of three patients achieved lesion clear-up under prednisone (0.2 mg/kg per day), and the other patient's pemphigus disease area index dropped from 39 to 3 with prednisone (15 mg/day).
• The anti-desmoglein antibody levels and CD19+B cell counts declined compared to those at baseline.
• There were no severe adverse events within the 24-week follow-up.

"In summary, we propose a protocol of ofatumumab for patients with refractory pemphigus vulgaris and report positive treatment outcomes of three patients who received this regimen," the researchers concluded.

Reference:

Zhang, X., Xiao, Y., Li, X., Wang, J., Zhou, X., Zhou, Y., Wang, M., Li, W., & Wang, Y. Ofatumumab subcutaneous injection successfully treated patients with pemphigus vulgaris relapse post rituximab. The Journal of Dermatology. https://doi.org/10.1111/1346-8138.17108