What are your preferred treatment options for recalcitrant pemphigus vulgaris?

Rituximab, typically combined with short-term corticosteroids, is the preferred treatment for recalcitrant pemphigus vulgaris, demonstrating superior efficacy compared to conventional immunosuppressants. In patients with moderate-to-severe disease, rituximab achieved sustained complete remission in 40% versus 10% with mycophenolate mofetil at 52 weeks, with significantly fewer disease flares (6 versus 44) and lower cumulative glucocorticoid exposure. When used as first-line therapy, rituximab pl...