Ofatumumab subcutaneous injection successfully treated patients with pemphigus vulgaris relapse post rituximab.

The therapeutic strategy for the treatment of pemphigus vulgaris (PV) still needs optimization because of the multiple deficiencies of glucocorticoid and rituximab. Ofatumumab, another CD20 monoclonal antibody administrated subcutaneously, provides a possible alternative option. In this study, three patients experienced PV relapse after clinical remission induced by rituximab. With written informed consent, they received an ofatumumab (20 mg) subcutaneous injection twice (2 weeks apart) in combination with a prednisone dose adjusted according to their weight and disease severity. Over the 24-week observation, two of three patients achieved lesion clear-up under prednisone (0.2 mg/kg per day), and the other patient's pemphigus disease area index dropped from 39 to 3 with prednisone (15 mg/day). The anti-desmoglein antibody levels and CD19+B cell counts declined compared to those at baseline. No severe adverse events were observed within the 24-week follow-up. In summary, we propose a protocol of ofatumumab for patients with refractory PV and report positive treatment outcomes of three patients who received this regimen.