Despite the effectiveness of rituximab in treating pemphigus, its role in subepidermal autoimmune blistering diseases remains unclear and is currently limited to off-label use. 

A recent meta-analysis of case reports, case series and retrospective studies on the effectiveness and safety of rituximab in bullous pemphigoid, mucous membrane pemphigoid, ocular pemphigoid and epidermolysis bullosa acquisita, compared remission and relapse rates in patients who received rituximab with those who only received conventional medical therapy. It also made comparisons among disease subgroups. 

This analysis suggests that:

•  Patients with subepidermal autoimmune blistering diseases treated with rituximab achieve a higher rate of complete remission and encounter their first relapse after a longer time interval. 
• Time to remission and total relapse rates remains similar between groups. 
• Adverse events and mortality rates were not common in patients who received rituximab. 
• The limitation of the study was the absence of randomized controlled trials and the observation that rituximab was employed as a late rescue therapy in most reports. 

This study shows that rituximab may be effective in subepidermal blistering disease, but randomized controlled studies must validate the current observational data.

Source: Tan WH, Sim J, Sultana R, et al. Rituximab in subepidermal blistering diseases. Dermatology. 2023;239(1):5-11.