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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pemphigus is an autoimmune disease that causes blisters and erosions and is characterized by autoantibodies to desmogleins&#46; Its prognosis was dismal until 1959&#44; when the introduction of corticosteroids revolutionized treatment and drastically reduced associated deaths&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Corticosteroids have been the first-line treatment for pemphigus ever since&#46; Long-term high-dose corticosteroid therapy achieves high remission rates&#44; but comes with considerable adverse effects&#46; Immunosuppressive drugs and immunomodulators are often used as corticosteroid-sparing agents in an attempt to reduce these effects&#44; but there is limited evidence on their effectiveness &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Rituximab &#40;RTX&#41; is an anti-CD20 monoclonal antibody that has been used off-label to treat pemphigus for several decades&#46; It is used particularly to treat patients with refractory disease or who are unable to tolerate conventional treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The results of the first multicenter&#44; prospective&#44; open-label&#44; randomized trial comparing the efficacy of RTX combined with low-dose prednisone &#40;RTX-LDPRD&#41; with that of long-term high-dose prednisone as monotherapy &#40;HD-PDN&#41; were recently published&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> The study included 90 adults recently diagnosed with untreated pemphigus vulgaris or pemphigus foliaceus&#46; The RTX-LDPRD group received 1<span class="elsevierStyleHsp" style=""></span>g of RTX on days 0 and 14&#44; followed by 500<span class="elsevierStyleHsp" style=""></span>mg at months 12 and 18 together with 0&#46;5 or 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d of prednisone tapered over 3 months for moderate disease or 6 months for severe disease&#46; The HD-PRD group received 1 or 1&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d of prednisone tapered over 12 or 18 months &#40;for moderate and severe disease&#44; respectively&#41;&#46; The follow-up period for both groups was 36 months&#46; Significant results were observed at 24 months&#58; 89&#37; &#40;41&#47;46&#41; of the patients in the RTX-LDPRD group achieved complete remission without treatment &#40;CR-WT&#41; versus 34&#37; &#40;15&#47;44&#41; of those in the HD-PRD group &#40;relative risk&#44; 2&#46;61&#59; 95&#37; CI&#44; 1&#46;71-3&#46;99&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; Time to CR-WT was shorter in the RTX-LDPRD group &#40;277 vs&#46; 677 days&#41; and these patients also experienced longer disease-free periods &#40;466 vs&#46; 62 days&#44; representing a 7-fold difference&#41;&#46; The cumulative dose of corticosteroids was 3 times lower in patients treated with RTX-LDPRD&#44; who also had fewer serious adverse effects &#40;27 events in 16 patients vs&#46; 53 events in 29 patients&#41;&#46; There were no differences in number of infections&#46; The most common adverse effects were endocrine&#44; muscular&#44; and bone disorders&#46; The recurrence rate in the first 24 months was 24&#37; in the RTX-LDPRD group and 45&#37; in the HD-PRD group&#46; Just 1 of the patients in the RTX-LDPRD group who achieved CR-WT at month 24 experienced recurrence over the next 12 months&#46; In brief&#44; patients treated with RTX combined with low-dose corticosteroids responded better&#44; faster&#44; and for longer and also had fewer recurrences and adverse effects&#46; Treatment cost per patient was 5500 Euro more expensive in the RTX-LDPRD group but this difference is of little significance if we consider the associated reductions in adverse effects&#44; work absenteeism&#44; and indirect health costs&#46; The results of this trial suggest that RTX could revolutionize the treatment of pemphigus&#44; replacing corticosteroid therapy as the first-line treatment option&#46;</p></span>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; The mortality rate in patients treated with corticosteroids is &#60;<span class="elsevierStyleHsp" style=""></span>10&#37;&#46; However&#44; mortality is more closely linked to treatment side effects than to the disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; Adjuvant therapy with immunosuppressive drugs reduces recurrence but no clear evidence has been found for its association with higher complete response rates or fewer adverse effects&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; Intravenous immunoglobulin therapy can increase complete clinical response rates&#46;&nbsp;\t\t\t\t\t\t\n
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Resident's Forum
Rituximab: Revolutionizing the Treatment of Pemphigus
FR-Rituximab, una revolución en el tratamiento del pénfigo
D. Morgado-Carrasco, P. Giavedoni, X. Fustà-Novell, P. Iranzo
Autor para correspondencia
piranzo@clinic.cat

Corresponding author.
Dermatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pemphigus is an autoimmune disease that causes blisters and erosions and is characterized by autoantibodies to desmogleins&#46; Its prognosis was dismal until 1959&#44; when the introduction of corticosteroids revolutionized treatment and drastically reduced associated deaths&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Corticosteroids have been the first-line treatment for pemphigus ever since&#46; Long-term high-dose corticosteroid therapy achieves high remission rates&#44; but comes with considerable adverse effects&#46; Immunosuppressive drugs and immunomodulators are often used as corticosteroid-sparing agents in an attempt to reduce these effects&#44; but there is limited evidence on their effectiveness &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Rituximab &#40;RTX&#41; is an anti-CD20 monoclonal antibody that has been used off-label to treat pemphigus for several decades&#46; It is used particularly to treat patients with refractory disease or who are unable to tolerate conventional treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The results of the first multicenter&#44; prospective&#44; open-label&#44; randomized trial comparing the efficacy of RTX combined with low-dose prednisone &#40;RTX-LDPRD&#41; with that of long-term high-dose prednisone as monotherapy &#40;HD-PDN&#41; were recently published&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> The study included 90 adults recently diagnosed with untreated pemphigus vulgaris or pemphigus foliaceus&#46; The RTX-LDPRD group received 1<span class="elsevierStyleHsp" style=""></span>g of RTX on days 0 and 14&#44; followed by 500<span class="elsevierStyleHsp" style=""></span>mg at months 12 and 18 together with 0&#46;5 or 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d of prednisone tapered over 3 months for moderate disease or 6 months for severe disease&#46; The HD-PRD group received 1 or 1&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d of prednisone tapered over 12 or 18 months &#40;for moderate and severe disease&#44; respectively&#41;&#46; The follow-up period for both groups was 36 months&#46; Significant results were observed at 24 months&#58; 89&#37; &#40;41&#47;46&#41; of the patients in the RTX-LDPRD group achieved complete remission without treatment &#40;CR-WT&#41; versus 34&#37; &#40;15&#47;44&#41; of those in the HD-PRD group &#40;relative risk&#44; 2&#46;61&#59; 95&#37; CI&#44; 1&#46;71-3&#46;99&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; Time to CR-WT was shorter in the RTX-LDPRD group &#40;277 vs&#46; 677 days&#41; and these patients also experienced longer disease-free periods &#40;466 vs&#46; 62 days&#44; representing a 7-fold difference&#41;&#46; The cumulative dose of corticosteroids was 3 times lower in patients treated with RTX-LDPRD&#44; who also had fewer serious adverse effects &#40;27 events in 16 patients vs&#46; 53 events in 29 patients&#41;&#46; There were no differences in number of infections&#46; The most common adverse effects were endocrine&#44; muscular&#44; and bone disorders&#46; The recurrence rate in the first 24 months was 24&#37; in the RTX-LDPRD group and 45&#37; in the HD-PRD group&#46; Just 1 of the patients in the RTX-LDPRD group who achieved CR-WT at month 24 experienced recurrence over the next 12 months&#46; In brief&#44; patients treated with RTX combined with low-dose corticosteroids responded better&#44; faster&#44; and for longer and also had fewer recurrences and adverse effects&#46; Treatment cost per patient was 5500 Euro more expensive in the RTX-LDPRD group but this difference is of little significance if we consider the associated reductions in adverse effects&#44; work absenteeism&#44; and indirect health costs&#46; The results of this trial suggest that RTX could revolutionize the treatment of pemphigus&#44; replacing corticosteroid therapy as the first-line treatment option&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Morgado-Carrasco D&#44; Giavedoni P&#44; Fust&#224;-Novell X&#44; Iranzo P&#46; FR-Rituximab&#44; una revoluci&#243;n en el tratamiento del p&#233;nfigo&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;177&#8211;178&#46;</p>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Bystryn et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Atzmony et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> and Wang et al&#46;<span class="elsevierStyleSup">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; Untreated pemphigus has a mortality rate of &#62;<span class="elsevierStyleHsp" style=""></span>70&#37;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46; The mortality rate in patients treated with corticosteroids is &#60;<span class="elsevierStyleHsp" style=""></span>10&#37;&#46; However&#44; mortality is more closely linked to treatment side effects than to the disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46; Adjuvant therapy with immunosuppressive drugs reduces recurrence but no clear evidence has been found for its association with higher complete response rates or fewer adverse effects&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46; Intravenous immunoglobulin therapy can increase complete clinical response rates&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; Rituximab has achieved complete clinical response rates of &#62;<span class="elsevierStyleHsp" style=""></span>75&#37; in clinical trials and case series&#46;&nbsp;\t\t\t\t\t\t\n
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