What is novel in the clinical management of pemphigus vulgaris?

ABSTRACT

Introduction

Pemphigus, an uncommon autoimmune blistering disorder affecting the skin and mucous membranes, currently with mortality primarily attributed to adverse reactions resulting from treatment protocols. Additionally, the existing treatments exhibit a notable recurrence rate. The high incidence of relapse and the considerable adverse effects associated with treatment underscore the imperative to explore safer and more effective therapeutic approaches. Numerous potential therapeutic targets have demonstrated promising outcomes in trials or preliminary research stages. These encompass anti-CD-20 agents, anti-CD-25 agents, TNF-α inhibition, FAS Ligand Inhibition, FcRn inhibition, BAFF inhibition, Bruton’s tyrosine kinase (BTK) inhibition, CAAR T Cells, JAK inhibition, mTOR inhibition, abatacept, IL-4 inhibition, IL-17 inhibition, IL-6 inhibition, polyclonal Regulatory T Cells, and autologous hematopoietic stem cell transplantation.

Areas covered

The most significant studies regarding the impact and efficacy of the mentioned treatments on pemphigus were meticulously curated through a comprehensive search conducted on the PubMed database. Moreover, the investigations of interest cited in these studies were also integrated.

Expert opinion

The efficacy and safety profiles of the other treatments under discussion do not exhibit the same level of robustness as anti-CD20 therapy, which is anticipated to endure as a critical element in pemphigus treatment well into the foreseeable future.

KEYWORDS:

• Pemphigus
• emerging treatments
• immunotherapy
• targeted therapy
• anti-CD20
• novel therapeutic targets

Article highlights

• In pemphigus, cost, rate of complete remission, mean time to complete remission, mean time to relapse, and safety are factors determining the quality of treatments.

• Anti-CD20 therapy presents substantial efficacy and safety profiles in the therapeutic approach to pemphigus vulgaris, underscoring its potential as a robust treatment modality for this condition in clinical practice.

• When compared to anti-CD20 therapies, the efficacy and safety profiles of other discussed treatments do not seem to be as robust.

• Anti-CD20 therapy is likely to persist as the main treatment of pemphigus well into the foreseeable future.

• Recent humanized anti-CD20 agents, characterized by improved safety profiles and available in subcutaneous formulations, have the potential to replace the currently widely utilized chimeric RTX.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.