What treatment regimen do you start for patients who present with mucous membrane pemphigoid?

The treatment plan for mucous membrane pemphigoid (MMP) is individualized based on the disease severity, medical comorbidities, patient preferences, and medication availability/cost.

For severe MMP, yes, I commonly use the combination of Rituxan, IVIG along with high dose systemic corticosteroids (1-2mg/kg/day). Rituxan takes 2-3 months to see the benefit, so the corticosteroids (e.g. prednisone) allow for more rapid disease control and the IVIG largely helps taper prednisone. IVIG even at doses of 1-2gm/kg/month, is not always very effective for MMP. It works variably well depending on the patient. The goal is to get them off prednisone and IVIG and just needing q6-12 month repeat Rituxan doses to maintain disease control until the diseas...