How do you manage patients with cicatricial pemphigoid refractory to doxycycline and dapsone?

In general, I’m rather aggressive about treating cicatricial pemphigoid given its ability to cause long-lasting sequela if left untreated and active. Pre-pandemic, rituximab was a common agent given its ability to put patients into a remission for extended periods of time. Now, given the data about rituximab in Covid, I’m much more likely to reach for other immunosuppressants such as mycophenolate or azathioprine. If immunosuppression is an absolute contraindication, IVIG may be a nice option.