What is novel in the clinical management of pemphigus

ABSTRACT

Introduction: Pemphigus, an autoimmune disease group characterized by blisters and erosions of the skin and/or mucosal membranes has been treated with systemic corticosteroids (CS) and immunosuppressive therapies for the past few decades.

Areas Covered: However, common adverse effects and complications of long-term CS and immunosuppressive drugs are limiting their long-term use. The disease results in death if not treated. Thus, currently, researchers are trying to develop new and safer therapeutic approaches. Specifically, targeted therapies to pathogenic immune pathways are under investigation. The B cell inhibitors which block CD20 and CD19 are the main new drugs investigated in clinical trials as alternatives to systemic steroids.

Expert Opinion: Randomized controlled trial (RCT) Level evidence shows that rituximab and short course CSs are more effective and safer than standard CS treatment. Specific BTK inhibitors have shown promise in data from a phase II international open-label study. Further studies are ongoing.

KEYWORDS:

• Pemphigus
• treatment
• management
• targeted therapies
• rituximab
• BTK inhibitors
• ofatumumab

Article highlights

● RTX is now approved for the initial treatment of adults with PV based on the ground-breaking study of Joly et al. as a first-line treatment combined with short-term CS in patients with newly diagnosed, moderate to severe PV.

● PRN1008 (Bruton tyrosine kinase inhibitor) seems as an emerging therapeutic option which is more convenient than injectable therapies such as RTX.

● SYNT001, a humanized IgG4 mAb specifically inhibiting neonatal Fc receptor (FcRn) binding to IgG, demonstrated a tolerable and safe profile for patients with active PV and PF in a preliminary study. This targeted therapy might have great potential to be beneficial in pemphigus.

● Future research should be a focus on firstly discovering the specific pathogenic molecules and cytokines and then creating better targeted therapies.

Declaration of interest

DF Murrell is an investigator and advisory board member for Principia-biopharma and was an investigator and advisor for Roche, GSK/Novartis, and Lilly. The authors have no other 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 apart from those disclosed.

Reviewer Disclosures

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

Additional information

Funding

This paper was not funded.