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2025, Vol: 9, Issue: 9
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Review Article
Online Published: 03 Sep 2025
 


Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis

Hosam Hadi Awaji, Fatmah Abdluraheem Jeddo, Saif Talal Almaghrabi, Rahaf Yaser Khayat, Taif Mohammed Alamri, Horyah Saeed Bakhsh, Marwah Yasser Qadi, Lama Abdullah Almujaydil, Ahmed Mohammed Alolyan, Fatema Maki Isa, Abdulaziz Ibrahim Alassaf, Raghad Ibraheem Abosoudah, Fatma Khider Faraj.


Abstract
Pemphigus is an autoimmune blistering condition that significantly impacts patient morbidity and quality of life. Rituximab has revolutionized treatment, but high-dose regimens are associated with considerable side effects and costs. Low-dose (LD) Rituximab has emerged as a promising alternative, offering the potential for comparable efficacy with reduced adverse events. To identify the efficacy and safety of LD Rituximab in pemphigus cases, with a focus on different dosing regimens. A total of 16 studies comprising 228 subjects were enrolled. All included studies evaluated the efficacy of LD Rituximab in pemphigus individuals, covering research conducted from inception through January 2025. Pooled proportions for complete remission and adverse events were calculated, and subgroup analyses were performed based on Rituximab dosing regimens. The overall rate of pooled remission was 72.9% [95% confidence intervals (CI): 64.2%-81.7%, p < 0.001], with the 500 mg × 2 regimens achieving the highest remission rate (74.8%). The pooled adverse event rate was 28.1% (95% CI: 16.4%-39.8%), with the ultra-LD regimen showing the lowest rate (15.5%). Significant heterogeneity was noted across studies. LD Rituximab is a highly effective and relatively safe therapy for pemphigus vulgaris. The 500 mg × 2 regimen offers the best balance of efficacy and safety, but further high-quality research is required to confirm such findings and identify long-term outcomes.

Key words: Pemphigus, rituximab, safety, low-dose therapy, meta-analysis


 
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How to Cite this Article
Pubmed Style

Awaji HH, Jeddo FA, Almaghrabi ST, Khayat RY, Alamri TM, Bakhsh HS, Qadi MY, Almujaydil LA, Alolyan AM, Isa FM, Alassaf AI, Abosoudah RI, Faraj FK. Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis. IJMDC. 2025; 9(7): 1709-1721. doi:10.24911/IJMDC.51-1753459385

Web Style

Awaji HH, Jeddo FA, Almaghrabi ST, Khayat RY, Alamri TM, Bakhsh HS, Qadi MY, Almujaydil LA, Alolyan AM, Isa FM, Alassaf AI, Abosoudah RI, Faraj FK. Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis. https://www.ijmdc.com/?mno=273302 [Access: October 14, 2025]. doi:10.24911/IJMDC.51-1753459385

AMA (American Medical Association) Style

Awaji HH, Jeddo FA, Almaghrabi ST, Khayat RY, Alamri TM, Bakhsh HS, Qadi MY, Almujaydil LA, Alolyan AM, Isa FM, Alassaf AI, Abosoudah RI, Faraj FK. Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis. IJMDC. 2025; 9(7): 1709-1721. doi:10.24911/IJMDC.51-1753459385


Vancouver/ICMJE Style

Awaji HH, Jeddo FA, Almaghrabi ST, Khayat RY, Alamri TM, Bakhsh HS, Qadi MY, Almujaydil LA, Alolyan AM, Isa FM, Alassaf AI, Abosoudah RI, Faraj FK. Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis. IJMDC. (2025), [cited October 14, 2025]; 9(7): 1709-1721. doi:10.24911/IJMDC.51-1753459385


Harvard Style

Awaji, H. H., Jeddo, . F. A., Almaghrabi, . S. T., Khayat, . R. Y., Alamri, . T. M., Bakhsh, . H. S., Qadi, . M. Y., Almujaydil, . L. A., Alolyan, . A. M., Isa, . F. M., Alassaf, . A. I., Abosoudah, . R. I. & Faraj, . F. K. (2025) Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis. IJMDC, 9 (7), 1709-1721. doi:10.24911/IJMDC.51-1753459385


Turabian Style

Awaji, Hosam Hadi, Fatmah Abdluraheem Jeddo, Saif Talal Almaghrabi, Rahaf Yaser Khayat, Taif Mohammed Alamri, Horyah Saeed Bakhsh, Marwah Yasser Qadi, Lama Abdullah Almujaydil, Ahmed Mohammed Alolyan, Fatema Maki Isa, Abdulaziz Ibrahim Alassaf, Raghad Ibraheem Abosoudah, and Fatma Khider Faraj. 2025. Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis. International Journal of Medicine in Developing Countries, 9 (7), 1709-1721. doi:10.24911/IJMDC.51-1753459385


Chicago Style

Awaji, Hosam Hadi, Fatmah Abdluraheem Jeddo, Saif Talal Almaghrabi, Rahaf Yaser Khayat, Taif Mohammed Alamri, Horyah Saeed Bakhsh, Marwah Yasser Qadi, Lama Abdullah Almujaydil, Ahmed Mohammed Alolyan, Fatema Maki Isa, Abdulaziz Ibrahim Alassaf, Raghad Ibraheem Abosoudah, and Fatma Khider Faraj. "Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis." International Journal of Medicine in Developing Countries 9 (2025), 1709-1721. doi:10.24911/IJMDC.51-1753459385


MLA (The Modern Language Association) Style

Awaji, Hosam Hadi, Fatmah Abdluraheem Jeddo, Saif Talal Almaghrabi, Rahaf Yaser Khayat, Taif Mohammed Alamri, Horyah Saeed Bakhsh, Marwah Yasser Qadi, Lama Abdullah Almujaydil, Ahmed Mohammed Alolyan, Fatema Maki Isa, Abdulaziz Ibrahim Alassaf, Raghad Ibraheem Abosoudah, and Fatma Khider Faraj. "Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis." International Journal of Medicine in Developing Countries 9.7 (2025), 1709-1721. Print. doi:10.24911/IJMDC.51-1753459385


APA (American Psychological Association) Style

Awaji, H. H., Jeddo, . F. A., Almaghrabi, . S. T., Khayat, . R. Y., Alamri, . T. M., Bakhsh, . H. S., Qadi, . M. Y., Almujaydil, . L. A., Alolyan, . A. M., Isa, . F. M., Alassaf, . A. I., Abosoudah, . R. I. & Faraj, . F. K. (2025) Safety and efficacy of low-dose rituximab in pemphigus: insights from a systematic review and a single-arm meta-analysis. International Journal of Medicine in Developing Countries, 9 (7), 1709-1721. doi:10.24911/IJMDC.51-1753459385




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