Rituximab in Mucous Membrane Pemphigoid: Current Evidence and Clinical Perspectives

Background: Mucous membrane pemphigoid (MMP) is a chronic, debilitating disease associated with significant morbidity. Progressive fibrosis of affected mucosal surfaces may result in irreversible complications, including blindness secondary to cicatricial conjunctivitis, esophageal strictures, laryngeal stenosis causing airway compromise, and genitourinary scarring with functional impairment. The management of MMP is still extremely challenging. Objectives: To assess the demographic and clinical characteristics of patients with MMP diagnosed and treated in our clinic during the past 5 years, and to analyze the evolution of the disease under conventional and biologic treatments. Methods: We conducted a retrospective study of patients with MMP treated in our clinic between January 2021 and May 2026. Results: We identified eight patients with MMP. The time from onset of the disease until diagnosis ranged from 1 month to 10 years. Seven patients had already developed significant complications of the disease, including esophageal stenosis, vision impairment, or unilateral vision loss. The disease exhibited progressive worsening in all patients, despite treatment with glucocorticoids, immunosuppressants, or immunomodulatory medication. Rituximab was administered to six patients. Although disease control was achieved in all cases, continuation of systemic conventional treatment was required. The mean time to significant clinical improvement was 2 months. One patient suffered a severe relapse 12 months following rituximab administration and required additional doses. Conclusions: Based on our experience, we support the early use of rituximab in high-risk patients with MMP. Prompt diagnosis and early, aggressive treatment in the inflammatory phase are essential to prevent scarring.