Comparison of rituximab and intravenous immunoglobulin in the treatment of autoimmune bullous diseases: Real-life data from a single centre.

BACKGROUND/AIM: Rituximab (RTX) and intravenous human immunoglobulin (IVIG) have been shown to be effective in the treatment of autoimmune bullous diseases (ABD), mainly pemphigus vulgaris (PV). The present study aimed to assess the clinical response of patients with ABD, mainly PV to RTX, IVIG and combined regimen of both. Whether adding IVIG to RTX therapy affects the achievement of complete remission off therapy (CR off), reduces time to CR off, time to steroid cessation, and decreases relapse rate was also investigated. METHODS: Data of 33 patients with ABD [PV (93.9%)], including clinical response to treatment, steroid cessation time, time to CR off and relapse, were recruited from medical charts. RESULTS: CR off and relapse rate, mean time to CR off and relapse was 86.7% (n = 13) vs 60.0% (n = 6) and 53.3% (n = 8) vs 40% (n = 4), 12.77 ± 9.30 vs 11.25 ± 13.40 and 24.1 ± 16.7 vs 13.0 ± 3.6 months in RTX and combination group, respectively. Older age (P = .005), younger age at the time of diagnosis (P = .004), lesser disease duration to the initiation of RTX (P = .004), lesser BMI (P = .026) and female gender (P = .037) were associated factors with CR off. CONCLUSION: Adding IVIG to RTX did not increase CR off rates; it also did not decrease time to CR off, time to steroid cessation, relapse rates and did not increase time to relapse. Patient and disease characteristics, including age, younger age at the time of diagnosis, lesser disease duration before RTX treatment, lesser BMI and female gender, are factors associated with CR off.

Comparison of Early and Late Onset Psoriasis (EOP and LOP) Regarding Systemic Inflammatory Comorbidities: LOP is a More Rapid Subtype of Psoriasis.

Introduction: Early onset psoriasis (EOP) and late onset psoriasis (LOP) differ regarding genetic background, clinical presentation and course of disease. Objectives: In this study, comparison of EOP and LOP regarding systemic inflammatory comorbidities which are frequently seen in psoriasis and determination of possible differences is aimed. Methods: A total of 160 plaque psoriasis patients (121 with EOP and 39 with LOP) were enrolled for the study. Data was collected with face-to-face questionnaire and patients medical chart evaluation. Collected data included medical and family history, clinical features and parameters indicating severity of psoriasis, results of laboratory work-up, physical and dermatological examination findings, presence of joint and nail involvement and associated inflammatory systemic comorbidities such as cardiovascular diseases (CVD), diabetes mellitus (DM), hypertension (HT), metabolic syndrome (MS), obesity. Results: Nail involvement and PsA occurred more rapidly in LOP compared to EOP (P < 0.01, P < 0.01). Compared frequencies in LOP and EOP were 7.7% versus 0.8% for CVD, 38.5% versus 14% for HT, 33.3% versus 9.9% for DM and 44.7% versus 24.8% for MS, respectively. CVD, HT, DM and MS were significantly more frequent in LOP compared to EOP (P = 0.045, P = 0.001, P < 0.01, P = 0.022). Results of multivariate analysis performed taking into account the age, gender, severity parameters of disease, alcohol consumption, smoking habits and other concurrent systemic comorbidities revealed LOP to be an independent risk factor for CVD and DM (P < 0.01, R2: 0.036, P < 0.01, R2: 0.077). Conclusions: LOP seems to interact with systemic comorbidities hence generates more severe inflammatory burden and shows a more rapid course.