Dr. Delphine Lee, director of the Dermatological Center for Skin Health at Providence Saint John’s Health Center in Santa Monica, California, told Reuters Health, “Since rituximab targets B cells, this case report provides additional evidence for the role of B cells mediating this autoimmune blistering disease.”
“While we still are not certain what the cells are doing to contribute to the disease, the fact that antibodies against transglutaminase were decreased after the treatment and also paralleled the patient’s resolution of the rash suggests that it may be that the antibody production by B cells which plays an important role,” she observed.
Dr. Lee concluded, “It’s great to see this report in the literature to provide additional ideas for those of us with patients suffering from DH with limited response to conventional therapies.”
Dermatologist Dr. Tien Nguyen of Orange Coast Memorial Medical Center in Fountain Valley, California, told Reuters Health, “DH is a very rare disease and management has been a real challenge since no effective drug is available to date. For severe cases when the blistering and itching are not being controlled, and when options for immunosuppressive drugs are running out, we have no choice but to look for more aggressive and non-FDA approved treatments.”
“In these situations, patients are commonly referred to tertiary care centers or university and academic settings for management,” he observed. “Obtaining insurance coverage for rituximab for non-FDA-approved usage will not be possible either.”
“However, the case is very interesting and definitely showed hope and a positive response, in this single case,” he concluded. “More data will be needed to convince the medical community to accept (rituximab) as another choice.”
- Albers LN, Zone JJ, Stoff BK, et al. Rituximab Treatment for Recalcitrant Dermatitis Herpetiformis. JAMA Dermatol. 2016 Dec 28. doi: 10.1001/jamadermatol.2016.4676. [Epub ahead of print]