NEW DIRECTIONS IN THE TREATMENT OF PEMPHIGUS VULGARIS? SAFETY AND EFFICACY OF RITUXIMAB AND DUPILUMAB – REVIEW OF LITERATURE

Background. Recent years have demonstrated a considerable development of biological treatment of various autoimmune diseases. Lack of response and adverse effects of standard treatment have been pushing research to find new therapeutic agents with good efficacy and safety profile. Aim. This study reviews the current knowledge about the potential use of rituximab and dupilumab, two biological drugs, in the treatment of pemphigus vulgaris (PV), a debilitating skin disease. Material and methods. The article is based on research of clinical trials and case studies published on the PubMed and Cochrane databases using the following keywords: pemphigus vulgaris, rituximab, dupilumab. Results. The existing trials show that rituximab offers faster achievement of complete remission when compared to standard prednisone or mycophenolate mofetil treatment. It also reduces the cumulative prednisone dose followed by alleviation of steroid-related adverse events. Its effect is even visible on the molecular level, being the depletion of T-helper cells that play a crucial role in activation of anti-desmoglein antibody producing B-memory cells. The use of dupilumab in PV has only been documented in a few case studies, which still show that most patients with refractory PV benefited from dupilumab treatment by finally achieving and maintaining remission. Conclusions. Despite limited randomized studies and small patient groups, the results of the existing research suggest a promising role of biological agents in the future treatment of patients with pemphigus vulgaris.