Albers LN, et al. - This study was executed in order to determine the biomarkers to speculate the relapse of pemphigus following rituximab therapy. It was deduced that a correlation existed between the relapse with B-cell repopulation, low CD4+ T -cell count, and positive result of testing for desmoglein 1 (Dsg1) and desmoglein 3 (Dsg3).

Methods

• Longitudinal clinical scoring and biomarker data was obtained from 62 patients with pemphigus, treated with 99 rituximab cycles.
• It including levels of CD19+ B cells, CD4+ T cells, and desmoglein 1 (Dsg1) and desmoglein 3 (Dsg3) autoantibodies.
• The extended time-variant Kaplan-Meier estimator and extended Cox model werew applied

Results

• Rare relapse was found before B-cell repopulation.
• Univariate analysis exhibited low CD4 count (<400 cells/μL) to predict relapse (P < .001).
• A positive result of testing for Dsg1 (>20 IU) speculated the relapse among patients with mucocutaneous disease (hazard ratio, 6.40; P = .019).
• A positive result of testing for Dsg3 (>20 IU) appeared to be predictive in patients with mucocutaneous and mucosal disease (hazard ratio, 32.92; P < .001).
• It was determined that CD4 value increase of 200 caused a decrease in the hazard ratio for relapse by 35% (P = .029), unveiled by the multivariable analysis.
• A positive result of testing for Dsg1 increased the risk for relapse by a factor of 12.32 in patients with mucocutaneous disease (P = .001).
• Positive result of testing for Dsg3 raised the risk for relapse by 28.38 in patients with mucosal and mucocutaneous disease (P = .006).