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Anti-CD20 Agents and Potential Novel Biologics in Pemphigus Vulgaris and Other Autoimmune Blistering Diseases

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Biologic and Systemic Agents in Dermatology

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Abstract

Pemphigus vulgaris (PV) is an autoimmune blistering disease caused by antibodies to desmoglein, a component of desmosomes in skin. Conventional treatment of PV is immunosuppressive therapy with corticosteroids, cyclophosphamide, azathioprine, and mycophenolate mofetil, which dampens the autoimmune response globally. Side effects can be severe, and treatment requires close monitoring. The emergence of anti-CD20 agents for autoimmune diseases and hematologic neoplasms has established a focus on selective B lymphocyte targeting, eliminating some of the severe side effects of chronic global immunosuppression. Rituximab is well characterized in the treatment of PV resistant to conventional therapies. Dosing and administration schedules for off-label use and safety profile of rituximab are discussed, as well as other anti-CD20 biologics and potential selective targets of immune effectors.

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Abbreviations

ADCC:

Antibody-dependent cellular cytotoxicity

APRIL:

A proliferation-inducing ligand

BAFF:

B-cell activating factor of the tumor necrosis factor family

BAFF-R:

BAFF receptor

BCMA:

B-cell maturation antigen

BP:

Bullous pemphigoid

CDC:

Complement-dependent cytotoxicity

EBA:

Epidermolysis bullosa acquisita

HACA:

Human anti-chimeric antibodies

IV:

Intravenous

IVIG:

High-dose intravenous immunoglobulin

mAb:

Monoclonal antibody

MMP:

Mucous membrane pemphigoid

PAIA:

Protein A immunoadsorption

PV:

Pemphigus vulgaris

RA:

Rheumatoid arthritis

SLE:

Systemic lupus erythematosus

SLO:

Secondary lymphoid organ

TACI:

Transmembrane activator and calcium modulator ligand interactor

TNF:

Tumor necrosis factor

TReg :

Regulatory T cells

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Author information

Authors and Affiliations

  1. Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA

    Amy Huang MD & Raman K. Madan MD

  2. Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Fifth Floor, Box 1048, New York, NY, 10029, USA

    Lauren Bonomo BA & Jacob Levitt MD

Authors
  1. Amy Huang MD
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  2. Raman K. Madan MD
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  3. Lauren Bonomo BA
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  4. Jacob Levitt MD
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Correspondence to Jacob Levitt MD .

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Editors and Affiliations

  1. Division of Dermatology, David Geffen School of Medicine a UCLA, Los Angeles, California, USA

    Paul S. Yamauchi

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Huang, A., Madan, R.K., Bonomo, L., Levitt, J. (2018). Anti-CD20 Agents and Potential Novel Biologics in Pemphigus Vulgaris and Other Autoimmune Blistering Diseases. In: Yamauchi, P. (eds) Biologic and Systemic Agents in Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-66884-0_34

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  • DOI: https://doi.org/10.1007/978-3-319-66884-0_34

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