When rituximab, an antibody which was first used to treat B cell lymphoma, became a treatment for pemphigus vulgaris, clinicians could choose to prescribe either a "lymphoma dose" or an "RA dose." A lymphoma-dose regimen of rituximab is a more aggressive approach to treatment compared to the dosing method for patients with rheumatoid arthritis. What's more, the U.S. Food and Drug Administration (FDA) now has an approved dosing regimen for pemphigus vulgaris, but it closely resembles the often less-effective RA dose. While both lymphoma and RA dosing approaches deplete B cells that cause disease, the lymphoma regimen takes into account a person's height and weight to determine a dose and is given weekly for four weeks. A rheumatoid arthritis dose is a fixed dose of two 1000 mg infusions given two weeks apart. The odds of complete remission for patients on a lymphoma regimen were 2.7 times greater compared to patients on a RA regimen suggesting that the FDA-approved regimen for pemphigus may not be ideal.
The rationale for using the rheumatoid arthritis regimen for pemphigus patients is that like pemphigus, rheumatoid arthritis is a B-cell-mediated autoimmune disease, as opposed to a B cell cancer where the total number of B cells greatly exceeds those in an autoimmune patient. Because the FDA-approved dose for pemphigus vulgaris is the same as the RA dose, some patients have insurance that only covers the RA regimen of the very-expensive medication. And on top of all that, rituximab is an immunosuppressant, so higher doses may risk higher rates of infection.
Reasons - Physicians - Medication - Study - Author
"All these reasons made it logical for physicians to use the medication more conservatively," said the study's senior author...
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