Australian guidelines for managing pemphigus diseases should be updated to include the anti-CD20 monoclonal antibody rituximab as a first-line therapy option, clinicians urge.

They say current advice for oral prednisolone 1-1.5mg/kg/day alone or with immunosuppressants to be used first line in moderate or severe pemphigus has been overtaken by “overwhelming evidence” for the biologic.

Globally, there has been a shift towards the preferential use of rituximab in combination with a tapering regimen of oral corticosteroids for this indication, they noted in a review article.

The WA doctors have called on the Council of Australian Therapeutic Advisory Groups to adopt a similar approach for treating moderate-to-severe pemphigus as the US and Europe.