How do you tailor rituximab dosing for mucosal-predominant vs mucocutaneous pemphigus?

In pemphigus specifically, my approach to dosing rituximab is not typically dictated by clinical phenotype. Interestingly, while anti-desmoglein 1 antibody level reductions following rituximab have been correlated with improved treatment response when compared with desmoglein 3 antibody level changes, to date, current literature does not support alternative rituximab dosing regimens for mucosal predominant vs. mucocutaneous pemphigus. Similarly, this study was insufficiently powered to investiga...

No, I do not dose cutaneous vs mucocutaneous patients with pemphigus differently with rituximab. I am more likely to recommend rituximab as first-line therapy if a patient has severe oral or genital disease, as this can be very quality-of-life limiting. Furthermore, relapse assessment can be challenging in oral disease patients, as many patients continue to have fragility and traumatic ulcerations but do not necessarily warrant further rituximab therapy, so in those patients, I tend to check ant...