RITUXIMAB is a safe and effective treatment for pemphigus foliaceus (PF), achieving complete remission in three-quarters of patients, according to a new systematic review and meta-analysis. The findings provide further evidence supporting current European recommendations to use rituximab as first-line therapy for moderate-to-severe PF.
PF is a rare autoimmune blistering disease, and evidence for rituximab has historically been limited because therapeutic trials have included relatively few patients. To address this gap, researchers conducted a systematic review and meta-analysis to evaluate the efficacy and safety of rituximab in PF.
The review, conducted according to PRISMA guidelines, identified 24 studies published between 2012 and 2025, including a total of 195 patients with PF. The median follow-up was 24.5 months.
Rituximab was used as first-line therapy in 21% of patients and second-line therapy in 46.7%, most commonly alongside oral corticosteroids (69.7%).
Across the included studies, the pooled complete remission (CR) rate was 75.0% (95% CI: 64.0–83.0), with patients reaching CR after a median of 9 months.
The analysis found no significant difference in efficacy between the lymphoma protocol and the rheumatoid arthritis protocol for rituximab administration (p=0.80), suggesting that both dosing strategies achieve comparable clinical outcomes.
Although remission rates were high, disease recurrence remained relatively common. The pooled relapse rate was 38.0% (95% CI: 26.0–51.0), with relapse occurring a median of 12.5 months after the first rituximab treatment cycle.
Twenty serious adverse events (SAEs) were reported across the studies, with infections accounting for 65% of these events. Overall, the authors considered rituximab to have an acceptable safety profile in patients with PF.
The researchers note that the available evidence is derived largely from observational studies involving relatively small patient numbers, reflecting the rarity of PF. Nevertheless, this represents the largest synthesis of evidence to date.
The findings support rituximab as an effective treatment option for PF and reinforce current European guideline recommendations advocating its use as first-line therapy in patients with moderate-to-severe disease.
Reference
Kieffer C et al. Efficacy and safety of rituximab in pemphigus foliaceus: a systematic review and meta-analysis. Dermatol Ther (Heidelb). 2026;DOI: 10.1007/s13555-026-01811-0.
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