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azathioprine&#44; mycophenolate&#44; methotrexate&#44; chlorambucil or dapsone&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;2</span></a> This challenging benefit&#8211;risk balance leads to a constant search for newer and safer therapies&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Rituximab has been used for the treatment of autoimmune bullous diseases&#46; Standard doses approved for lymphomas &#40;375<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> weekly for 4 weeks&#41; and rheumatoid arthritis &#40;RA&#41; &#40;two infusions of 1000<span class="elsevierStyleHsp" style=""></span>mg repeated in 2 weeks&#41; are the most used protocols&#44; and have shown to be effective in pemphigus vulgaris &#40;PV&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;4</span></a> BP&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a> and other autoimmune bullous diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> A low-dose rituximab protocol of two infusions of 500<span class="elsevierStyleHsp" style=""></span>mg has also been used for PV&#44; showing a good safety profile and therapeutic response&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;4</span></a> Thus&#44; we hypothesized this lower dose might be effective also in BP&#46; Herein we report our experience in the treatment of BP with low-dose rituximab&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patients</span><p id="par0015" class="elsevierStylePara elsevierViewall">This retrospective&#44; single-center case series included patients with BP treated with low-dose rituximab at Hospital Universitario Ram&#243;n y Cajal &#40;Madrid&#44; Spain&#41; between September 2019 and April 2020&#46; Diagnosis of BP was established by clinical&#44; histological and immunological criteria&#44; according to the European guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> All patients had failure for initial control after treatment with conventional therapies for a minimum of 4 weeks&#44; as defined by the International Pemphigoid Committee&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Treatment with low-dose rituximab was approved by our institution as an off-label compassionate use&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Pretreatment workup</span><p id="par0020" class="elsevierStylePara elsevierViewall">Pretreatment workup included a complete blood test&#44; chest X-ray&#44; Mantoux test&#44; and several microbiological studies to rule out viral infections including Hepatitis B virus&#44; Hepatitis C virus&#44; and HIV&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Treatment protocol</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients were premedicated with methylprednisolone 125<span class="elsevierStyleHsp" style=""></span>mg&#44; dexchlorpheniramine 5<span class="elsevierStyleHsp" style=""></span>mg&#44; and paracetamol 1<span class="elsevierStyleHsp" style=""></span>g intravenously the day of the infusion and the day after&#46; A single cycle of two infusions of rituximab 500<span class="elsevierStyleHsp" style=""></span>mg was administered with an interval of 14 days&#46; Vitals and immediate adverse effects were monitored during infusion and the day after&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Follow-up and end points</span><p id="par0030" class="elsevierStylePara elsevierViewall">Frequency of follow-up visits and laboratory investigations were performed considering individual patients&#8217; general condition&#46; End points and outcome measures were defined according to the International Pemphigoid Committee<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> as &#40;a&#41; &#8220;Disease control&#8221;&#58; time at which new lesions or pruritus cease to form and established lesions begin to heal&#59; &#40;b&#41; &#8220;End of consolidation phase&#8221;&#58; time at which no new lesions or pruritus have developed for a minimum of 2 weeks and the majority &#40;approximately 80&#37;&#41; of established lesions has healed&#59; &#40;c&#41; &#8220;Complete remission during tapering&#8221;&#58; absence of nontransient lesions while the patient is receiving more than minimal therapy&#59; &#40;d&#41; &#8220;Complete remission&#8221;&#58; absence of new or established lesions or pruritus for at least 2 months while the patient is off all BP therapy &#40;CR OFF&#41; or with minimal therapy &#40;CR ON&#41;&#59; &#40;e&#41; &#8220;Partial remission&#8221;&#58; presence of transient new lesions that heal within 1 week for at least 2 months while the patient is off all BP therapy &#40;PR OFF&#41; or with minimal therapy &#40;PR ON&#41;&#46; &#8220;Minimal therapy&#8221; is defined as less than or equal to 0&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day of prednisone &#40;or the equivalent&#41; or 20<span class="elsevierStyleHsp" style=""></span>g&#47;week of clobetasol propionate and&#47;or minimal adjuvant therapy &#40;methotrexate 5<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#59; azathioprine 0&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#59; mycophenolate mofetil 500<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#59; or dapsone 50<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">Five male and one female patients with a mean age of 78&#46;6 years &#40;range 65&#8211;89&#41; were included&#46; Their mean Charlson comorbidity index was 5&#46;6 &#40;range 3&#8211;9&#41;&#46; The mean history of BP before rituximab treatment was 6&#46;7 months &#40;range 2&#8211;16&#41;&#44; and it was associated with Alzheimer&#39;s disease in two patients and dipeptidyl peptidase-4 &#40;DPP-4&#41; inhibitors intake in one patient&#46; Prior to rituximab&#44; all patients had received conventional systemic therapy including prednisone &#40;six patients&#41;&#44; doxycycline &#40;four patients&#41; or azathioprine &#40;three patients&#41;&#44; in addition to clobetasol propionate cream 0&#46;05&#37; &#40;six patients&#41;&#46; The patients were followed-up for a mean of 52 weeks &#40;range 6&#8211;77&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> show patients&#8217; characteristics and end points&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Early end points</span><p id="par0040" class="elsevierStylePara elsevierViewall">We observed a rapid and marked response after the two infusions of rituximab &#40;probably influenced also by the premedication with methylprednisolone&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The mean time to disease control was 1&#46;9 weeks &#40;range 1&#8211;3&#41;&#44; and the mean time to end of consolidation phase was 4 weeks &#40;range 3&#8211;5&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Late end points</span><p id="par0045" class="elsevierStylePara elsevierViewall">After a single cycle of low-dose rituximab&#44; four patients &#40;80&#37;&#41; achieved a late end point at a mean of 15&#46;75 weeks &#40;range 13&#8211;20&#41;&#44; which was maintained at the time of writing this article&#44; for a mean of 28&#46;75 weeks &#40;range 16&#8211;38&#41;&#46; Three patients achieved partial remission&#58; two with no need of any medication &#40;PR OFF&#41;&#44; and one with minimal therapy &#40;PR ON&#41; &#40;prednisone 5<span class="elsevierStyleHsp" style=""></span>mg plus clobetasol propionate cream 0&#46;05&#37;&#44; and clobetasol propionate cream 0&#46;05&#37; alone&#44; respectively&#41;&#46; One patient achieved complete remission with no therapy &#40;CR OFF&#41;&#46; One patient has 6 weeks of follow-up&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The remaining patient achieved disease control at 1 week&#44; but relapsed 4 weeks after the rituximab treatment&#46; However&#44; he remains in complete remission during tapering with more than minimal adjuvant therapy &#40;CR adj&#41; &#40;prednisone 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day and azathioprine 50<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Adverse events</span><p id="par0055" class="elsevierStylePara elsevierViewall">One patient presented with oral erosions and vesicles 2 months after rituximab treatment&#46; It was diagnosed with herpetic gingivostomatitis &#40;confirmed by PCR&#41; and resolved with oral valacyclovir&#46; Another patient who had a claw hand secondary to a stroke developed a pressure ulcer requiring a finger amputation 1&#46;5 months after rituximab treatment&#44; yet a direct link with rituximab is unlikely&#46; No other serious adverse events occurred during the follow-up&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Rituximab is a humanized chimeric monoclonal antibody directed against CD-20 antigen on B lymphocytes&#44; with several approved and off-label indications&#46; It has been recently approved by the US Food and Drug Administration &#40;FDA&#41; in 2018&#44; and the European Medicines Agency &#40;EMA&#41; in 2019 as a treatment for PV&#46; Since then&#44; there are increasing articles reporting the treatment of BP with rituximab at standard doses &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a> Lymphoma protocol is more commonly used than RA protocol&#44; although one study found no difference in the efficacy between them&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> At these standard doses&#44; complete remission ranged between 35&#37;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> and 85&#37;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> of the patients&#44; and partial remission between 15&#37;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> and 40&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> These studies reported serious adverse events&#44; mainly infectious&#44; and even cases of deaths&#46; Overall&#44; data suggest that rituximab at standard doses is effective in BP&#44; and also useful as an steroid- and immunosuppressant-sparing therapy but may have serious adverse effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a> In addition&#44; a recently published study has shown that mortality in patients with BP treated with rituximab is lower than in those receiving standard treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Low-dose rituximab has been reported to be effective in a myriad of autoimmune diseases&#44; such as myasthenia gravis&#44; rheumatoid arthritis or immune thrombocytopenia&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> In Dermatology&#44; low-dose rituximab has been mainly used in PV&#44; with satisfactory data in effectiveness and safety&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;4</span></a> A meta-analysis by Wang et al&#46; found no difference between standard doses and low-dose in time to disease control&#44; complete remission rate and relapse rate in patients with PV&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In our study&#44; we present six patients with BP treated with low-dose rituximab &#40;two infusions of 500<span class="elsevierStyleHsp" style=""></span>mg&#41;&#44; which is 39&#37; of the dose used in hematology and 50&#37; of the dose used in rheumatology&#44; with an acceptable effectiveness and safety profile&#46; The administration of high doses of methylprednisolone has probably produced this rapid beneficial effect as observed in other diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> but good long-term control of the disease is derived from the use of rituximab&#46; Only 1 patient of our series experienced a mild adverse event&#44; compared to several serious adverse events with standard doses&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a> CR &#40;including off therapy&#44; minimal therapy and more than minimal therapy&#41; was achieved in 40&#37; of the patients &#40;compared to 35<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&#8211;85&#37;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> with standard doses&#41;&#44; and PR in 60&#37; of the patients &#40;compared to 15<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a>&#8211;40&#37;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> with standard doses&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Only 1 patient relapsed and had to continue with immunosuppressive therapy&#44; supporting that low-dose rituximab is also useful to avoid steroids and immunosuppressants&#44; decreasing the morbidity and adverse events in advanced age BP patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We highlight that these are dependent patients&#44; with high comorbidity and polymedication&#44; leading to a low adherence to first-line treatment &#40;high-potency topical corticosteroids&#41;&#46; The aim of this treatment is to improve the quality of life of the patients&#44; reducing their needed care without increasing side effects&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Our study had several limitations&#44; including its retrospective nature&#44; small sample size and a short follow-up period that does not allow to see the effects in the very long term&#46; However&#44; to our knowledge this is the first series of BP treated with low-dose rituximab and it will be useful for future prospective studies&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion&#44; low-dose rituximab for the treatment of BP achieved acceptable remission rates and steroid-sparing activity&#44; with a better safety profile and a lower cost&#44; compared to standard doses&#46; Although future studies are needed&#44; this pilot study suggests that low-dose rituximab could be a therapeutic option for BP&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding sources</span><p id="par0090" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Background</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Low-dose rituximab is a protocol used in several autoimmune diseases&#44; that has also shown to be effective and safe in pemphigus vulgaris&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Objectives</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To study whether low-dose rituximab is also effective for bullous pemphigoid&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients with BP were treated with a single cycle of two infusions of rituximab 500<span class="elsevierStyleHsp" style=""></span>mg at an interval of 2 weeks&#46; Early and late end points were monitored&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Six patients&#44; five males and a female&#44; with a mean age of 78&#46;6 years &#40;range 65&#8211;89&#41; and a mean history of BP of 6&#46;7 months &#40;range 2&#8211;16&#41; were included&#46; A rapid and marked response was observed after a single cycle of treatment&#44; with a mean time to disease control and to end of consolidation phase of 1&#46;9 &#40;range 1&#8211;3&#41;&#44; and 4 weeks &#40;range 3&#8211;5&#41;&#44; respectively&#46; Four patients achieved a late end point at a mean of 15&#46;75 weeks &#40;range 13&#8211;20&#41;&#46; Three of them achieved partial remission with no therapy &#40;two patients&#41; or with minimal therapy &#40;one patient&#41;&#44; and one of them achieved complete remission with no therapy&#46; One patient has 6 weeks of clinical follow-up after rituximab administration&#46; The remaining patient relapsed 4 weeks after the rituximab treatment&#44; and remains in complete remission with more than minimal therapy&#46; One patient had a herpetic gingivostomatitis related to rituximab&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Low-dose rituximab for BP achieved acceptable remission rates and steroid-sparing activity&#44; with a better safety profile and a lower cost&#44; compared to standard doses&#46; This pilot study suggests that low-dose rituximab could be a therapeutic option for BP&#46;</p></span>"
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        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Antecedentes</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La administraci&#243;n de dosis bajas de rituximab es un protocolo utilizado en diversas enfermedades autoinmunes&#44; que ha demostrado tambi&#233;n su eficacia y seguridad para el p&#233;nfigo vulgar&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Determinar si rituximab a dosis bajas es efectivo para el penfigoide ampolloso &#40;PA&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">M&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se trat&#243; a los pacientes con PA con un ciclo &#250;nico de 2 infusiones de rituximab 500<span class="elsevierStyleHsp" style=""></span>mg con un intervalo de 2 semanas&#46; Se monitorizaron los puntos temprano y final tard&#237;o&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el estudio 6 pacientes&#44; 5 varones y una mujer&#44; con una edad media de 78&#44;6 a&#241;os &#40;rango&#58; 65&#46;89&#41; e historia media de PA de 6&#44;7 meses &#40;rango&#58; 2-16&#41;&#46; Se observ&#243; una respuesta r&#225;pida y acusada tras un ciclo &#250;nico de tratamiento&#44; con un tiempo medio hasta el control de la enfermedad y el final de la fase de consolidaci&#243;n de 1&#44;9 &#40;rango&#58; 1-3&#41; y 4 semanas &#40;rango&#58; 3-5&#41;&#44; respectivamente&#46; Cuatro pacientes lograron un punto final tard&#237;o a una media de 15&#44;75 semanas &#40;rango&#58; 13-20&#41;&#46; Tres de ellos lograron una remisi&#243;n parcial sin terapia &#40;2 pacientes&#41; o con terapia m&#237;nima &#40;un paciente&#41;&#44; logrando uno de ellos la remisi&#243;n completa sin terapia&#46; A un paciente se le realiz&#243; un seguimiento de 6 semanas tras la administraci&#243;n de rituximab&#46; El paciente restante sufri&#243; una reca&#237;da transcurridas 4 semanas del tratamiento de rituximab&#44; permaneciendo en remisi&#243;n completa con terapia m&#237;nima&#46; Un paciente manifest&#243; gingivoestomatitis herp&#233;tica relacionada con rituximab&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La administraci&#243;n de dosis bajas de rituximab para PA logr&#243; tasas de remisi&#243;n aceptables y reducci&#243;n de esteroides&#44; con un mejor perfil de seguridad y un menor coste&#44; en comparaci&#243;n con las dosis est&#225;ndar&#46; Este estudio piloto sugiere que la administraci&#243;n de bajas dosis de rituximab podr&#237;a ser una opci&#243;n terap&#233;utica para el PA&#46;</p></span>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Disease phases and end points after rituximab treatment&#46; Each bar represents a patient and its length shows the duration of follow-up&#46; After a single cycle of low-dose rituximab &#40;at week 0&#41;&#44; the time to disease control &#40;blue&#41;&#44; the time to end of consolidation &#40;red&#41;&#44; the time to late end point &#40;yellow&#41; and its duration &#40;green&#41; are shown&#46; One patient had a relapse &#40;black line&#41;&#44; requiring retreatment with more than minimal adjuvant therapy &#40;light blue&#41;&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CR adj&#58; complete remission with more than minimal adjuvant therapy &#40;also referred to &#8220;complete remission during tapering&#8221;&#41;&#59; CR OFF&#58; complete remission off all therapy&#59; CR ON&#58; complete remission with minimal therapy&#59; PR OFF&#58; partial remission off all therapy&#59; PR ON&#58; partial remission with minimal therapy&#46;</p>"
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        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AZA&#44; azathioprine&#59; CLOB&#44; clobetasol propionate cream 0&#46;05&#37;&#59; CR OFF&#44; complete remission off all therapy&#59; DOXY&#44; doxycycline&#59; GDS&#58; global deterioration scale&#59; PRED&#58; prednisone&#59; PR OFF&#44; partial remission off all therapy&#59; PR ON&#44; partial remission with minimal therapy&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex&#47;age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">History of the disease &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Associated conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Previous therapies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adverse events of rituximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Disease control at week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Late end point &#40;at week&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Minimal therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Relapse at week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up &#40;weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#47;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gliptin intake&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AZA &#40;50 mg&#41;&#44; PRED &#40;30 mg&#41;&#44; CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PR OFF &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#47;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AZA &#40;75 mg&#47;day&#41;&#44; DOXY &#40;100 mg&#47;day&#41;&#44; PRED &#40;20 mg&#47;day&#41;&#44; CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Herpetic gingiva-stomatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PR ON &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED 5<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#47;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED &#40;30 mg&#47;day&#41;&#44; DOXY &#40;100 mg&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#47;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alzheimer &#40;GDS<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED &#40;20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; DOXY &#40;100 mg&#47;day&#41;&#44; CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CR OFF &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#47;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alzheimer &#40;GDS<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED &#40;30 mg&#47;day&#41;&#44; CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PR OFF &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED &#40;20 mg&#47;day&#41;&#44;CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; clinical characteristics and outcomes of patients with bullous pemphigoid treated with low-dose rituximab&#46;</p>"
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      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">CR adj&#44; complete remission with more than minimal adjuvant therapy&#59; CR OF&#44; complete remission off all therapy&#59; CR ON&#44; complete remission with minimal therapy&#59; PR adj&#44; partial remission with more than minimal therapy&#59; PR OFF&#44; partial remission off all therapy&#59; PR ON&#44; partial remission with minimal therapy&#46; Lymphoma protocol &#40;375<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> weekly for 4 weeks&#41;&#59; RA&#58; rheumatoid arthritis protocol &#40;two infusions of 1000<span class="elsevierStyleHsp" style=""></span>mg repeated in 2 weeks&#41;&#59; RTX&#58; rituximab&#46;</p>"
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            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Current study&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Polansky et al&#46;&#44; 2019&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Kremer et al&#46;&#44; 2018&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tovanabutra et al&#46;&#44; 2019&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dose of RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 doses of 500<span class="elsevierStyleHsp" style=""></span>mg &#40;low-dose RTX&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58; Lymphoma19&#58; RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#58; Lymphoma27&#58; RA2&#58; other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#58; Lymphoma7&#58; RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complete remission&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;40&#37;&#41;- CR OFF&#58; 1 &#40;20&#37;&#41;- CR adj&#58; 1 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;35&#37;&#41;- CR OFF&#58; 2 &#40;10&#37;&#41;- CR ON&#58; 4 &#40;20&#37;&#41;- CR adj&#58; 1 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;85&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>- CR OFF or ON&#58; 40 &#40;65&#37;&#41;- CR adj&#58; 12 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;57&#37;&#41;- CR OFF&#58; 2 &#40;9&#46;5&#37;&#41;- CR ON&#58; 10 &#40;47&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Partial remission&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;60&#37;&#41;- PR OFF&#58; 2 &#40;40&#37;&#41;- PR ON&#58; 1 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;40&#37;&#41;- PR OFF&#58; 1 &#40;5&#37;&#41;- PR ON&#58; 3 &#40;15&#37;&#41;- PR adj&#58; 4 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;15&#37;&#41;Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;19&#37;&#41;- PR OFF&#58; 1 &#40;4&#46;7&#37;&#41;- PR ON&#58; 3 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time to remission&#44; mean &#40;range&#41;&#59; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;67 &#40;3&#8211;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6 &#40;1&#46;9&#8211;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relapse&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;24&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;76&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time from RTX to relapse&#44; mean &#40;range&#41;&#59; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8 &#40;10&#46;9&#8211;12&#46;6&#41; &#40;from first dose of RTX&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2 &#40;1&#8211;24&#41; &#40;from last dose of RTX&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Follow-up period&#44; mean &#40;range&#41;&#59; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;2 &#40;6&#46;8&#8211;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;9 &#40;4&#46;4&#8211;41&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;3&#8211;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;5 &#40;3&#46;7&#8211;101&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adverse effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 patient &#40;20&#37;&#41;&#44;Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 events- 15 hospitalizations- 0 deaths&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 patients &#40;24&#37;&#41;- 2 deaths&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 patients &#40;19&#37;&#41;-1 death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            ]
          ]
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">This study classified as CR OFF patients who were off therapy or treated with prednisone with a maximal dose of 10<span class="elsevierStyleHsp" style=""></span>mg&#46; Since the latter group is better defined as CR ON&#44; this group is expressed in the table as CR OFF or ON&#46; Also this study classified CR ON as patients with more than prednisone 10<span class="elsevierStyleHsp" style=""></span>mg and&#47;or other systemic therapies&#46; This group is expressed in the table as CR adj&#46;</p>"
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparison of outcomes between treatment of BP with low-dose rituximab &#40;current study&#41; and standard doses&#46;</p>"
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Brief Communication
Low-Dose Rituximab for Bullous Pemphigoid. Protocol and Single-Center Experience
Baja dosis de rituximab para penfigoide ampolloso. Protocolo y experiencia de un único centro
C. Suárez-Carantoñaa,c,1,
Corresponding author
ceciliasuca@gmail.com

Corresponding author.
, J. Jiménez-Cauhéb,1, A. González-Garcíaa, M. Fernández-Guarinob, M. Asunción Ballesterb
a Internal Medicine, Hospital Universitario Ramón y Cajal, Madrid, Spain
b Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
c Universidad de Alcalá, Alcalá de Henares, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bullous pemphigoid &#40;BP&#41; is the most frequent autoimmune blistering disease&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> Patients with BP have an increased morbidity and mortality resulting mainly from advanced age and underlying disorders&#44; but also from adverse events of the immunosuppressive therapies used for this condition&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;2</span></a> Topical and oral corticosteroids are the mainstay treatment for BP&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> Second line treatment includes several non-validated therapies such as tetracyclines&#44; azathioprine&#44; mycophenolate&#44; methotrexate&#44; chlorambucil or dapsone&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;2</span></a> This challenging benefit&#8211;risk balance leads to a constant search for newer and safer therapies&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Rituximab has been used for the treatment of autoimmune bullous diseases&#46; Standard doses approved for lymphomas &#40;375<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> weekly for 4 weeks&#41; and rheumatoid arthritis &#40;RA&#41; &#40;two infusions of 1000<span class="elsevierStyleHsp" style=""></span>mg repeated in 2 weeks&#41; are the most used protocols&#44; and have shown to be effective in pemphigus vulgaris &#40;PV&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;4</span></a> BP&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a> and other autoimmune bullous diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> A low-dose rituximab protocol of two infusions of 500<span class="elsevierStyleHsp" style=""></span>mg has also been used for PV&#44; showing a good safety profile and therapeutic response&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;4</span></a> Thus&#44; we hypothesized this lower dose might be effective also in BP&#46; Herein we report our experience in the treatment of BP with low-dose rituximab&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patients</span><p id="par0015" class="elsevierStylePara elsevierViewall">This retrospective&#44; single-center case series included patients with BP treated with low-dose rituximab at Hospital Universitario Ram&#243;n y Cajal &#40;Madrid&#44; Spain&#41; between September 2019 and April 2020&#46; Diagnosis of BP was established by clinical&#44; histological and immunological criteria&#44; according to the European guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> All patients had failure for initial control after treatment with conventional therapies for a minimum of 4 weeks&#44; as defined by the International Pemphigoid Committee&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Treatment with low-dose rituximab was approved by our institution as an off-label compassionate use&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Pretreatment workup</span><p id="par0020" class="elsevierStylePara elsevierViewall">Pretreatment workup included a complete blood test&#44; chest X-ray&#44; Mantoux test&#44; and several microbiological studies to rule out viral infections including Hepatitis B virus&#44; Hepatitis C virus&#44; and HIV&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Treatment protocol</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients were premedicated with methylprednisolone 125<span class="elsevierStyleHsp" style=""></span>mg&#44; dexchlorpheniramine 5<span class="elsevierStyleHsp" style=""></span>mg&#44; and paracetamol 1<span class="elsevierStyleHsp" style=""></span>g intravenously the day of the infusion and the day after&#46; A single cycle of two infusions of rituximab 500<span class="elsevierStyleHsp" style=""></span>mg was administered with an interval of 14 days&#46; Vitals and immediate adverse effects were monitored during infusion and the day after&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Follow-up and end points</span><p id="par0030" class="elsevierStylePara elsevierViewall">Frequency of follow-up visits and laboratory investigations were performed considering individual patients&#8217; general condition&#46; End points and outcome measures were defined according to the International Pemphigoid Committee<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> as &#40;a&#41; &#8220;Disease control&#8221;&#58; time at which new lesions or pruritus cease to form and established lesions begin to heal&#59; &#40;b&#41; &#8220;End of consolidation phase&#8221;&#58; time at which no new lesions or pruritus have developed for a minimum of 2 weeks and the majority &#40;approximately 80&#37;&#41; of established lesions has healed&#59; &#40;c&#41; &#8220;Complete remission during tapering&#8221;&#58; absence of nontransient lesions while the patient is receiving more than minimal therapy&#59; &#40;d&#41; &#8220;Complete remission&#8221;&#58; absence of new or established lesions or pruritus for at least 2 months while the patient is off all BP therapy &#40;CR OFF&#41; or with minimal therapy &#40;CR ON&#41;&#59; &#40;e&#41; &#8220;Partial remission&#8221;&#58; presence of transient new lesions that heal within 1 week for at least 2 months while the patient is off all BP therapy &#40;PR OFF&#41; or with minimal therapy &#40;PR ON&#41;&#46; &#8220;Minimal therapy&#8221; is defined as less than or equal to 0&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day of prednisone &#40;or the equivalent&#41; or 20<span class="elsevierStyleHsp" style=""></span>g&#47;week of clobetasol propionate and&#47;or minimal adjuvant therapy &#40;methotrexate 5<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#59; azathioprine 0&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#59; mycophenolate mofetil 500<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#59; or dapsone 50<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">Five male and one female patients with a mean age of 78&#46;6 years &#40;range 65&#8211;89&#41; were included&#46; Their mean Charlson comorbidity index was 5&#46;6 &#40;range 3&#8211;9&#41;&#46; The mean history of BP before rituximab treatment was 6&#46;7 months &#40;range 2&#8211;16&#41;&#44; and it was associated with Alzheimer&#39;s disease in two patients and dipeptidyl peptidase-4 &#40;DPP-4&#41; inhibitors intake in one patient&#46; Prior to rituximab&#44; all patients had received conventional systemic therapy including prednisone &#40;six patients&#41;&#44; doxycycline &#40;four patients&#41; or azathioprine &#40;three patients&#41;&#44; in addition to clobetasol propionate cream 0&#46;05&#37; &#40;six patients&#41;&#46; The patients were followed-up for a mean of 52 weeks &#40;range 6&#8211;77&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> show patients&#8217; characteristics and end points&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Early end points</span><p id="par0040" class="elsevierStylePara elsevierViewall">We observed a rapid and marked response after the two infusions of rituximab &#40;probably influenced also by the premedication with methylprednisolone&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The mean time to disease control was 1&#46;9 weeks &#40;range 1&#8211;3&#41;&#44; and the mean time to end of consolidation phase was 4 weeks &#40;range 3&#8211;5&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Late end points</span><p id="par0045" class="elsevierStylePara elsevierViewall">After a single cycle of low-dose rituximab&#44; four patients &#40;80&#37;&#41; achieved a late end point at a mean of 15&#46;75 weeks &#40;range 13&#8211;20&#41;&#44; which was maintained at the time of writing this article&#44; for a mean of 28&#46;75 weeks &#40;range 16&#8211;38&#41;&#46; Three patients achieved partial remission&#58; two with no need of any medication &#40;PR OFF&#41;&#44; and one with minimal therapy &#40;PR ON&#41; &#40;prednisone 5<span class="elsevierStyleHsp" style=""></span>mg plus clobetasol propionate cream 0&#46;05&#37;&#44; and clobetasol propionate cream 0&#46;05&#37; alone&#44; respectively&#41;&#46; One patient achieved complete remission with no therapy &#40;CR OFF&#41;&#46; One patient has 6 weeks of follow-up&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The remaining patient achieved disease control at 1 week&#44; but relapsed 4 weeks after the rituximab treatment&#46; However&#44; he remains in complete remission during tapering with more than minimal adjuvant therapy &#40;CR adj&#41; &#40;prednisone 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day and azathioprine 50<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Adverse events</span><p id="par0055" class="elsevierStylePara elsevierViewall">One patient presented with oral erosions and vesicles 2 months after rituximab treatment&#46; It was diagnosed with herpetic gingivostomatitis &#40;confirmed by PCR&#41; and resolved with oral valacyclovir&#46; Another patient who had a claw hand secondary to a stroke developed a pressure ulcer requiring a finger amputation 1&#46;5 months after rituximab treatment&#44; yet a direct link with rituximab is unlikely&#46; No other serious adverse events occurred during the follow-up&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Rituximab is a humanized chimeric monoclonal antibody directed against CD-20 antigen on B lymphocytes&#44; with several approved and off-label indications&#46; It has been recently approved by the US Food and Drug Administration &#40;FDA&#41; in 2018&#44; and the European Medicines Agency &#40;EMA&#41; in 2019 as a treatment for PV&#46; Since then&#44; there are increasing articles reporting the treatment of BP with rituximab at standard doses &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a> Lymphoma protocol is more commonly used than RA protocol&#44; although one study found no difference in the efficacy between them&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> At these standard doses&#44; complete remission ranged between 35&#37;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> and 85&#37;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> of the patients&#44; and partial remission between 15&#37;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> and 40&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> These studies reported serious adverse events&#44; mainly infectious&#44; and even cases of deaths&#46; Overall&#44; data suggest that rituximab at standard doses is effective in BP&#44; and also useful as an steroid- and immunosuppressant-sparing therapy but may have serious adverse effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a> In addition&#44; a recently published study has shown that mortality in patients with BP treated with rituximab is lower than in those receiving standard treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Low-dose rituximab has been reported to be effective in a myriad of autoimmune diseases&#44; such as myasthenia gravis&#44; rheumatoid arthritis or immune thrombocytopenia&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> In Dermatology&#44; low-dose rituximab has been mainly used in PV&#44; with satisfactory data in effectiveness and safety&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;4</span></a> A meta-analysis by Wang et al&#46; found no difference between standard doses and low-dose in time to disease control&#44; complete remission rate and relapse rate in patients with PV&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In our study&#44; we present six patients with BP treated with low-dose rituximab &#40;two infusions of 500<span class="elsevierStyleHsp" style=""></span>mg&#41;&#44; which is 39&#37; of the dose used in hematology and 50&#37; of the dose used in rheumatology&#44; with an acceptable effectiveness and safety profile&#46; The administration of high doses of methylprednisolone has probably produced this rapid beneficial effect as observed in other diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> but good long-term control of the disease is derived from the use of rituximab&#46; Only 1 patient of our series experienced a mild adverse event&#44; compared to several serious adverse events with standard doses&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a> CR &#40;including off therapy&#44; minimal therapy and more than minimal therapy&#41; was achieved in 40&#37; of the patients &#40;compared to 35<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&#8211;85&#37;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> with standard doses&#41;&#44; and PR in 60&#37; of the patients &#40;compared to 15<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a>&#8211;40&#37;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> with standard doses&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Only 1 patient relapsed and had to continue with immunosuppressive therapy&#44; supporting that low-dose rituximab is also useful to avoid steroids and immunosuppressants&#44; decreasing the morbidity and adverse events in advanced age BP patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We highlight that these are dependent patients&#44; with high comorbidity and polymedication&#44; leading to a low adherence to first-line treatment &#40;high-potency topical corticosteroids&#41;&#46; The aim of this treatment is to improve the quality of life of the patients&#44; reducing their needed care without increasing side effects&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Our study had several limitations&#44; including its retrospective nature&#44; small sample size and a short follow-up period that does not allow to see the effects in the very long term&#46; However&#44; to our knowledge this is the first series of BP treated with low-dose rituximab and it will be useful for future prospective studies&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion&#44; low-dose rituximab for the treatment of BP achieved acceptable remission rates and steroid-sparing activity&#44; with a better safety profile and a lower cost&#44; compared to standard doses&#46; Although future studies are needed&#44; this pilot study suggests that low-dose rituximab could be a therapeutic option for BP&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding sources</span><p id="par0090" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span></span>"
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              "titulo" => "Late end points"
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    "fechaRecibido" => "2021-08-11"
    "fechaAceptado" => "2021-10-14"
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          "clase" => "keyword"
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            0 => "Bullous pemphigoid"
            1 => "Rituximab"
            2 => "Interdisciplinary"
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          "clase" => "keyword"
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            0 => "Penfigoide ampolloso"
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            2 => "Interdisciplinar"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Background</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Low-dose rituximab is a protocol used in several autoimmune diseases&#44; that has also shown to be effective and safe in pemphigus vulgaris&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Objectives</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To study whether low-dose rituximab is also effective for bullous pemphigoid&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients with BP were treated with a single cycle of two infusions of rituximab 500<span class="elsevierStyleHsp" style=""></span>mg at an interval of 2 weeks&#46; Early and late end points were monitored&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Six patients&#44; five males and a female&#44; with a mean age of 78&#46;6 years &#40;range 65&#8211;89&#41; and a mean history of BP of 6&#46;7 months &#40;range 2&#8211;16&#41; were included&#46; A rapid and marked response was observed after a single cycle of treatment&#44; with a mean time to disease control and to end of consolidation phase of 1&#46;9 &#40;range 1&#8211;3&#41;&#44; and 4 weeks &#40;range 3&#8211;5&#41;&#44; respectively&#46; Four patients achieved a late end point at a mean of 15&#46;75 weeks &#40;range 13&#8211;20&#41;&#46; Three of them achieved partial remission with no therapy &#40;two patients&#41; or with minimal therapy &#40;one patient&#41;&#44; and one of them achieved complete remission with no therapy&#46; One patient has 6 weeks of clinical follow-up after rituximab administration&#46; The remaining patient relapsed 4 weeks after the rituximab treatment&#44; and remains in complete remission with more than minimal therapy&#46; One patient had a herpetic gingivostomatitis related to rituximab&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Low-dose rituximab for BP achieved acceptable remission rates and steroid-sparing activity&#44; with a better safety profile and a lower cost&#44; compared to standard doses&#46; This pilot study suggests that low-dose rituximab could be a therapeutic option for BP&#46;</p></span>"
        "secciones" => array:5 [
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            "identificador" => "abst0010"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Objectives"
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          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Methods"
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        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Antecedentes</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La administraci&#243;n de dosis bajas de rituximab es un protocolo utilizado en diversas enfermedades autoinmunes&#44; que ha demostrado tambi&#233;n su eficacia y seguridad para el p&#233;nfigo vulgar&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Determinar si rituximab a dosis bajas es efectivo para el penfigoide ampolloso &#40;PA&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">M&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se trat&#243; a los pacientes con PA con un ciclo &#250;nico de 2 infusiones de rituximab 500<span class="elsevierStyleHsp" style=""></span>mg con un intervalo de 2 semanas&#46; Se monitorizaron los puntos temprano y final tard&#237;o&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el estudio 6 pacientes&#44; 5 varones y una mujer&#44; con una edad media de 78&#44;6 a&#241;os &#40;rango&#58; 65&#46;89&#41; e historia media de PA de 6&#44;7 meses &#40;rango&#58; 2-16&#41;&#46; Se observ&#243; una respuesta r&#225;pida y acusada tras un ciclo &#250;nico de tratamiento&#44; con un tiempo medio hasta el control de la enfermedad y el final de la fase de consolidaci&#243;n de 1&#44;9 &#40;rango&#58; 1-3&#41; y 4 semanas &#40;rango&#58; 3-5&#41;&#44; respectivamente&#46; Cuatro pacientes lograron un punto final tard&#237;o a una media de 15&#44;75 semanas &#40;rango&#58; 13-20&#41;&#46; Tres de ellos lograron una remisi&#243;n parcial sin terapia &#40;2 pacientes&#41; o con terapia m&#237;nima &#40;un paciente&#41;&#44; logrando uno de ellos la remisi&#243;n completa sin terapia&#46; A un paciente se le realiz&#243; un seguimiento de 6 semanas tras la administraci&#243;n de rituximab&#46; El paciente restante sufri&#243; una reca&#237;da transcurridas 4 semanas del tratamiento de rituximab&#44; permaneciendo en remisi&#243;n completa con terapia m&#237;nima&#46; Un paciente manifest&#243; gingivoestomatitis herp&#233;tica relacionada con rituximab&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La administraci&#243;n de dosis bajas de rituximab para PA logr&#243; tasas de remisi&#243;n aceptables y reducci&#243;n de esteroides&#44; con un mejor perfil de seguridad y un menor coste&#44; en comparaci&#243;n con las dosis est&#225;ndar&#46; Este estudio piloto sugiere que la administraci&#243;n de bajas dosis de rituximab podr&#237;a ser una opci&#243;n terap&#233;utica para el PA&#46;</p></span>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Disease phases and end points after rituximab treatment&#46; Each bar represents a patient and its length shows the duration of follow-up&#46; After a single cycle of low-dose rituximab &#40;at week 0&#41;&#44; the time to disease control &#40;blue&#41;&#44; the time to end of consolidation &#40;red&#41;&#44; the time to late end point &#40;yellow&#41; and its duration &#40;green&#41; are shown&#46; One patient had a relapse &#40;black line&#41;&#44; requiring retreatment with more than minimal adjuvant therapy &#40;light blue&#41;&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CR adj&#58; complete remission with more than minimal adjuvant therapy &#40;also referred to &#8220;complete remission during tapering&#8221;&#41;&#59; CR OFF&#58; complete remission off all therapy&#59; CR ON&#58; complete remission with minimal therapy&#59; PR OFF&#58; partial remission off all therapy&#59; PR ON&#58; partial remission with minimal therapy&#46;</p>"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Clinical picture of patient 4 the day of the first infusion of rituximab 500<span class="elsevierStyleHsp" style=""></span>mg &#40;A&#41; and the day of the second infusion after 2 weeks &#40;B&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AZA&#44; azathioprine&#59; CLOB&#44; clobetasol propionate cream 0&#46;05&#37;&#59; CR OFF&#44; complete remission off all therapy&#59; DOXY&#44; doxycycline&#59; GDS&#58; global deterioration scale&#59; PRED&#58; prednisone&#59; PR OFF&#44; partial remission off all therapy&#59; PR ON&#44; partial remission with minimal therapy&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Previous therapies&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Gliptin intake&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AZA &#40;50 mg&#41;&#44; PRED &#40;30 mg&#41;&#44; CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PR OFF &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#47;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AZA &#40;75 mg&#47;day&#41;&#44; DOXY &#40;100 mg&#47;day&#41;&#44; PRED &#40;20 mg&#47;day&#41;&#44; CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Herpetic gingiva-stomatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PR ON &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED 5<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#47;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED &#40;30 mg&#47;day&#41;&#44; DOXY &#40;100 mg&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#47;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alzheimer &#40;GDS<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED &#40;20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; DOXY &#40;100 mg&#47;day&#41;&#44; CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CR OFF &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#47;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alzheimer &#40;GDS<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED &#40;30 mg&#47;day&#41;&#44; CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PR OFF &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED &#40;20 mg&#47;day&#41;&#44;CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CLOB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; clinical characteristics and outcomes of patients with bullous pemphigoid treated with low-dose rituximab&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">CR adj&#44; complete remission with more than minimal adjuvant therapy&#59; CR OF&#44; complete remission off all therapy&#59; CR ON&#44; complete remission with minimal therapy&#59; PR adj&#44; partial remission with more than minimal therapy&#59; PR OFF&#44; partial remission off all therapy&#59; PR ON&#44; partial remission with minimal therapy&#46; Lymphoma protocol &#40;375<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> weekly for 4 weeks&#41;&#59; RA&#58; rheumatoid arthritis protocol &#40;two infusions of 1000<span class="elsevierStyleHsp" style=""></span>mg repeated in 2 weeks&#41;&#59; RTX&#58; rituximab&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Current study&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Polansky et al&#46;&#44; 2019&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Kremer et al&#46;&#44; 2018&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tovanabutra et al&#46;&#44; 2019&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dose of RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 doses of 500<span class="elsevierStyleHsp" style=""></span>mg &#40;low-dose RTX&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58; Lymphoma19&#58; RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#58; Lymphoma27&#58; RA2&#58; other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#58; Lymphoma7&#58; RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complete remission&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;40&#37;&#41;- CR OFF&#58; 1 &#40;20&#37;&#41;- CR adj&#58; 1 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;35&#37;&#41;- CR OFF&#58; 2 &#40;10&#37;&#41;- CR ON&#58; 4 &#40;20&#37;&#41;- CR adj&#58; 1 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;85&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>- CR OFF or ON&#58; 40 &#40;65&#37;&#41;- CR adj&#58; 12 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;57&#37;&#41;- CR OFF&#58; 2 &#40;9&#46;5&#37;&#41;- CR ON&#58; 10 &#40;47&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Partial remission&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;60&#37;&#41;- PR OFF&#58; 2 &#40;40&#37;&#41;- PR ON&#58; 1 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;40&#37;&#41;- PR OFF&#58; 1 &#40;5&#37;&#41;- PR ON&#58; 3 &#40;15&#37;&#41;- PR adj&#58; 4 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;15&#37;&#41;Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;19&#37;&#41;- PR OFF&#58; 1 &#40;4&#46;7&#37;&#41;- PR ON&#58; 3 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time to remission&#44; mean &#40;range&#41;&#59; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;67 &#40;3&#8211;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6 &#40;1&#46;9&#8211;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Relapse&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;24&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;76&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time from RTX to relapse&#44; mean &#40;range&#41;&#59; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8 &#40;10&#46;9&#8211;12&#46;6&#41; &#40;from first dose of RTX&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2 &#40;1&#8211;24&#41; &#40;from last dose of RTX&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Follow-up period&#44; mean &#40;range&#41;&#59; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;2 &#40;6&#46;8&#8211;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;9 &#40;4&#46;4&#8211;41&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;3&#8211;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;5 &#40;3&#46;7&#8211;101&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adverse effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 patient &#40;20&#37;&#41;&#44;Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 events- 15 hospitalizations- 0 deaths&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 patients &#40;24&#37;&#41;- 2 deaths&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 patients &#40;19&#37;&#41;-1 death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                      "titulo" => "Management of bullous pemphigoid&#58; the European Dermatology Forum consensus in collaboration with the European Academy of Dermatology and Venereology"
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                    0 => array:2 [
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                          "etal" => false
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                            2 => "T&#46; DeGrazia"
                            3 => "X&#46; Zhao"
                            4 => "Y&#46; Liu"
                            5 => "R&#46; Feldman"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2019.03.049"
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                      "titulo" => "Low-dose rituximab is effective in pemphigus"
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                        "fecha" => "2012"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Gupta"
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                            2 => "A&#46;N&#46; Shah"
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                        "tituloSerie" => "Indian J Dermatol Venereol Leprol"
                        "fecha" => "2017"
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                        "paginaInicial" => "317"
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                  "contribucion" => array:1 [
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                      "titulo" => "Rituximab and omalizumab for the treatment of bullous pemphigoid&#58; a systematic review of the literature"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                      "doi" => "10.1007/s40257-018-0401-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol"
                        "fecha" => "2019"
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ISSN: 00017310
Original language: English
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