Comparison of costs of two treatment options for pemphigus patients

Pemphigus vulgaris (PV) is a disease that causes painful blistering of the skin and mucous membranes. This rare, potentially life‐threatening condition is the most common form of pemphigus, affecting about 3 in every 100,000 people worldwide. Another rarer form of pemphigus is pemphigus foliaceus (PF) which involves only the skin. People with pemphigus are commonly treated with oral (by mouth) corticosteroids (prednisone); however, corticosteroids can have severe side effects such as diabetes, arterial hypertension or infections. A clinical trial called Ritux3, led by the French Study Group on Autoimmune Bullous Diseases showed that in newly diagnosed PV or PF patients, rituximab given through a vein along with a lower dose and shorter course of oral corticosteroids (rituximab plus prednisone) was more effective than the standard dose and duration of corticosteroids (prednisone‐alone). However, rituximab is an expensive drug which may be considered as a limitation of this treatment, whereas prednisone is extremely cheap. Using the data from the Ritux3 study, the authors compared the costs of the use of rituximab with low dose of prednisone versus the prednisone‐alone treatment, during a 3‐year follow‐up period. The authors found that the initial individual higher cost (over‐cost) related to rituximab was progressively counter‐balanced by the costs related to the management of uncontrolled disease and adverse events in the prednisone‐alone group. Thus, mean individual total cost over the 3 years of follow‐up was 13 997€ in the prednisone‐alone group versus 14 818€ in the rituximab group, corresponding to an over‐cost of 821€ per patient (+6%). Linked Article:   Hébert et al . Br J Dermatol 2020; 183 :121–127.