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Rituximab has been demonstrated to be effective for treatment of pemphigus vulgaris and pemphigus foliaceus in multiple open-label clinical trials. These diseases are thought to be caused by the direct effect of pathogenic autoantibodies (IgG1 and IgG4) on the desmogleins responsible for cell adhesion, dsg3 and dsg1. Rituximab is a chimeric IgG1 monoclonal antibody that targets the CD20 molecule, which is a transmembrane glycoprotein expressed exclusively on B cells.
Two groups of researchers recently studied rituximab’s efficacy and its mechanisms of action. Mouquet and colleagues extend the observations made in an earlier study of 21 patients with rituximab-treated severe pemphigus (see N Engl J Med 2007; 357:545). In the same group of pat…