Clinical Research Directory

Inclusion Criteria: * Written informed consent obtained from patient * Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult) * Newly or recently diagnosed (less than 18 months) diagnosed pemphigus vulgaris or pemphigus foliaceus based on clinical features; histological features of acantholysis via skin or mucosal biopsy; and intercellular staining pattern of indirect immunofluorescence or serological detection of DSG 1 or DSG 3 by enzyme-linked immunosorbent assay (ELISA) * Moderate to severe active disease, as defined by overall PDAI \>= 15 or skin involvement BSA\>= 5%. 9 \[Annex 1\] * Receiving standard-of-care oral prednisolone up to 1.5 mg/kg/day * Women who are sexually active and not postmenopausal, agreement to remain abstinent or use 2 effective methods of contraception. * Ability to comply with study protocol as deemed by investigator's assessment Exclusion criteria: * Age \<18 or \>75 * Pregnant women or nursing mother * Already diagnosed pemphigus patients diagnosed \> 18 months * Non-consenting patients, or patient who cannot be followed up regularly * Patient with history of serious allergy or anaphylactic reaction to monoclonal antibody treatment * Severe heart failure (NYHA Class III or IV) * Unstable angina or myocardiac infarction within last 3 months or post-infarction heart failure * Anaemia (haemoglobin \<10g/dL), Neutropenia (\<1000/mm3), Lymphopenia (\<900/mm3), thrombocytopenia (\<100,000/mm3) * Renal insufficiency eGFR \<60 * Liver insufficiency of ALT/ALT \> 2 times normal limit range * Positive test results for hepatitis C (HCV) serology at screening \*Patients who are HepBs Ag positive, or HepBs Ag negative and anti-HepBc Ab - positive: Patients who are HepBs Ag positive - will be started on entecavir 0.5mg daily, and will be referred to a gastroenterologist for further follow up. Patients who are HepBs Ag negative, and HBc Ab positive, with detectable HepB DNA levels - will be started on entecavir 0.5mg daily, and will be referred to a gastroenterologist for further follow up. Patients who are HepBs Ag negative, HBc Ab positive, with no detectable HepB DNA levels - will be started on entecavir 0.5mg daily, and will be continued on entecavir for at least 18 months after completion of last dose of rituximab. * Blood test positive for HIV * Signs of active infection on CXR * Positive interferon gamma release assay Quantiferon or T.Spot TB test: must be treated with at least 4 weeks post initiation of isoniazid or other TB therapy * Inherited or acquired severe immunodeficiency * History of malignancy * Patient with active severe infection (excluding fungal infections of the nail), which has required antibiotic treatment within 2 week prior to study enrolment * Infection requiring hospitalisation or intravenous antibiotic treatment within the last 8 weeks prior to enrolment * Past history of osteomyelitis, or fasciitis, septic arthritis within the last one year * Patients with drug induced pemphigus. A thorough medication history will be taken to rule out drug induced pemphigus including D-penicillamine, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and cephalosporins * Evidence of any new or uncontrolled concomitant disease that in the investigators' judgement would preclude the patients participation * Patients with history of allergy or adverse events to IVIG or rituximab treatment10 * Treatment with intravenous immunoglobulins, plasmaphoresis within the last 8 weeks prior to randomization * Previous treatment with rituximab or any monoclonal antibody inducing profound lymphopenia * Treatment with live or attenuated vaccine within the last 28 days prior to randomization