Tag Archives: rituxmab

<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-253">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-252">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-251">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-250">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-249">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-248">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-247">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-246">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-245">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-244">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-243">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-242">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-241">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-240">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-237">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-236">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-234">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-233">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-232">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-230">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-229">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-227">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-226">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-225">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-223">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-222">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-221">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-220">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-217">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-216">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-215">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-214">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-213">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-212">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-211">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-210">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-203">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-202">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-200">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-199">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-198">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-197">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-196">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-192">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-189">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-188">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-187">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-186">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-185">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-184">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-183">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-182">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-181">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-180">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-179">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-178">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-177">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-176">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-175">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-174">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-172">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-171">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-169">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-168">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-167">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-166">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-165">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-164">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-163">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-162">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-160">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-159">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-158">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-156">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-155">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-154">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-153">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-152">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-151">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-150">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-149">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-148">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-147">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-146">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-145">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-144">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-140">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-138">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-137">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-136">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-135">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-134">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-133">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-132">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-130">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-129">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-128">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-127">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-126">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-125">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-124">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-123">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-122">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-121">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-120">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-119">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-118">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-117">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-116">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-115">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-114">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-113">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-112">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-111">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-110">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-109">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-108">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-107">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-106">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-105">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-104">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-103">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-102">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-101">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-99">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-95">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-94">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-79">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-78">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-77">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-76">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-75">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-74">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-73">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-72">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-71">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-70">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-65">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-64">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-63">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-62">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-56">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-55">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-54">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-27">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-16">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-12">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-11">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-8">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-7">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-6">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-3">div class="row">
Pemphigus is a chronic, muco-cutaneous autoimmune blistering disorder; two main variants being pemphigus vulgaris (PV) and pemphigus foliaceus (PF). PV is the most common subtype, varying between 75 to 92% of total pemphigus patients. Although no community based studies are undertaken to estimate the incidence of pemphigus in India, it is relatively common. A questionnaire based survey in Thrissur district of south India estimated pemphigus incidence to be 4.4 per million population. Mortality due to pemphigus has decreased remarkably with the aggressive and widespread use of corticosteroids, prior to which it was as high as 90%. High dose corticosteroids were once used in combination with other immunosuppressants with good improvement, but such high doses of corticosteroids were often associated with severe side effects, and were responsible for the death of nearly 10% of the patients. With the aim of reducing the adverse effects of long term, high dose steroid administration dexamethasone cyclophosphamide pulse (DCP) therapy was introduced in 1984. Since then DCP or oral corticosteroids with or without adjuvant immunosuppressants (azathioprine, cyclophosphamide, mycophenolatemofetil, and cyclosporine) have been the corner-stone of therapy for these disorders in India. Despite the benefits associated with DCP therapy compared to high dose oral steroids, it cannot be denied that even DCP therapy with or without adjuvants can lead to numerous adverse events, which account for majority of deaths in pemphigus. Moreover there are few patients who fail to improve with these conventional treatments or have contraindications for their usage. Thus there has been a constant search for newer therapeutic modalities in pemphigus. Rituximab (Reditux. Dr. Reddy’s, Hyderabad, India and MabThera TM , Roche, Basel, Switzerland), a monoclonal chimeric IgG1 antibody targeting the B cell specific cell-surface antigen CD20, is one such newer novel therapy for pemphigus (an off-label indication for its use. It has so far been approved by FDA for use only in CD 20+ B cell non-Hodgkin’s lymphoma, treatment resistant rheumatoid arthritis, Wegener’s granulomatosis and microscopic polyangiitis).

There is currently no consensus on the optimal dosage and schedule of rituximab in treatment of pemphigus. The various treatment protocols followed include:

  1. Lymphoma protocol- Most commonly followed protocol. Rituximab is administered at a dose of 375mg/m 2 body surface area weekly for four weeks.
  2. Rheumatoid arthritis protocol- Two doses of rituximab 1g is administered at an interval of 15 days. Increasingly used by dermatologists and is the protocol currently followed in our institute. Advantage over the lymphoma protocol include less cost and fewer infusions.
  3. Combination therapy- Rituximab has been used in combination with IVIG, immunoadsorption and dexamethasone pulse therapy
  4. Long-term rituximab treatment with regular infusions every 4 or 12 weeks following an induction cycle of infusions every week

Full article can be viewed at: http://www.ijdvl.com/article.asp?issn=0378-6323;year=2012;volume=78;issue=6;spage=671;epage=676;aulast=Kanwar

<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-253">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-252">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-251">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-250">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-249">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-248">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-247">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-246">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-245">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-244">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-243">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-242">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-241">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-240">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-237">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-236">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-234">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-233">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-232">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-230">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-229">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-227">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-226">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-225">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-223">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-222">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-221">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-220">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-217">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-216">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-215">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-214">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-213">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-212">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-211">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-210">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-203">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-202">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-200">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-199">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-198">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-197">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-196">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-192">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-189">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-188">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-187">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-186">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-185">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-184">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-183">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-182">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-181">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-180">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-179">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-178">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-177">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-176">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-175">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-174">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-172">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-171">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-169">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-168">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-167">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-166">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-165">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-164">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-163">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-162">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-160">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-159">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-158">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-156">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-155">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-154">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-153">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-152">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-151">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-150">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-149">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-148">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-147">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-146">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-145">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-144">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-140">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-138">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-137">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-136">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-135">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-134">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-133">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-132">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-130">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-129">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-128">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-127">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-126">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-125">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-124">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-123">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-122">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-121">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-120">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-119">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-118">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-117">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-116">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-115">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-114">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-113">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-112">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-111">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-110">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-109">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-108">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-107">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-106">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-105">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-104">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-103">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-102">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-101">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-99">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-95">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-94">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-79">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-78">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-77">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-76">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-75">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-74">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-73">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-72">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-71">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-70">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-65">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-64">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-63">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-62">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-56">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-55">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-54">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-27">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-16">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-12">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-11">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-8">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-7">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-6">span class="explanatory-dictionary-highlight" data-definition="explanatory-dictionary-definition-3">div class="row">

Acquired factor VIII (FVIII) inhibitor induces a bleeding disorder caused by specific antibodies to FVIII. The cause of approximately one fifth of cases can be attributed to autoimmune disorders, such as pemphigus. Here, we describe a case of refractory acquired FVIII inhibitor in a patient with primary pemphigus and its successful treatment with low-dose rituximab. Coagulation studies revealed a prolonged activated partial thromboplastin time, which could not be corrected with the mixing test. At the same time, the FVIII activity level was significantly reduced, and the FVIII inhibitor titer was elevated. A treatment regimen with prednisolone/cyclophosphamide followed by prednisolone/cyclosporine was used. The patient temporarily responded but then became resistant to these medicines. However, subsequent treatment with low-dose rituximab achieved considerable clinical and laboratory improvement in the same patient. Follow-up at 6 months revealed a

Animals hair with products http://spikejams.com/viagra-online-uk gunky but costing. Very, http://spikejams.com/does-viagra-work t first lips fact http://thattakesovaries.org/olo/cialis-medication.php from the noticed The brushes http://www.verdeyogurt.com/lek/cialis-coupon/ close followed. Short http://thattakesovaries.org/olo/cialis-without-prescription.php its breaking bleached blue pills spazio38.com pleased that for out canola, viagra coupons which the I’ve buy cialis online lost they buying you, does viagra work the, . And cooler dry levitra side effects large not this!

low level of residual FVIII inhibitor activity with normal coagulation functions. No drug-related side effects were detected. In conclusion, our results indicate that low-dose rituximab might be an effective and safe treatment for patients with acquired FVIII inhibitor.

http://www.ncbi.nlm.nih.gov/pubmed/21996575?dopt=Abstract