Pemphigus vulgaris

disease
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Summary

Pemphigus vulgaris (MONDO:0008219) is a disease with 2 cohort genes (11 GWAS associations across 4 studies) and 39 clinical trials. Top therapeutic interventions include efgartigimod alfa, mycophenolate mofetil, and azathioprine.

At a glance

  • Prevalence: 1-5 / 10 000 (Europe) [Orphanet-validated]
  • Cohort genes: 2
  • GWAS associations: 11
  • Phenotypes (HPO): 20
  • Clinical trials: 39

Clinical features

Epidemiology

Prevalence records

8 prevalence record(s), Orphanet:

TypeClassValueGeographyValidation
Point prevalence1-5 / 10 00018EuropeValidated
Annual incidence1-9 / 1 000 0000.13FranceValidated
Annual incidence1-9 / 1 000 0000.7United KingdomValidated
Annual incidence<1 / 1 000 0000.076FinlandValidated
Annual incidence1-9 / 1 000 0000.47BulgariaValidated
Annual incidence1-9 / 1 000 0000.42United StatesValidated
Annual incidence1-9 / 1 000 0000.25TunisiaValidated
Point prevalence1-9 / 100 0009.482GermanyValidated

Signs & symptoms

Clinical features (HPO)

20 HPO clinical features (Orphanet curated; top 20 by frequency):

HPO IDTermFrequency
HP:0000987Atypical scarring of skinVery frequent (80-99%)
HP:0001025UrticariaVery frequent (80-99%)
HP:0001824Weight lossVery frequent (80-99%)
HP:0002719Recurrent infectionsVery frequent (80-99%)
HP:0002960AutoimmunityVery frequent (80-99%)
HP:0008872Feeding difficulties in infancyVery frequent (80-99%)
HP:0031446Erosion of oral mucosaVery frequent (80-99%)
HP:0100792AcantholysisVery frequent (80-99%)
HP:0100838Recurrent cutaneous abscess formationVery frequent (80-99%)
HP:0200097Oral mucosal blistersVery frequent (80-99%)
HP:0000716DepressionFrequent (30-79%)
HP:0000739AnxietyFrequent (30-79%)
HP:0008066Abnormal blistering of the skinFrequent (30-79%)
HP:0011968Feeding difficultiesFrequent (30-79%)
HP:0034194Suprabasal cleavageFrequent (30-79%)
HP:4000013Anti-desmoglein-1 antibody positivityFrequent (30-79%)
HP:4000014Anti-desmoglein-3 antibody positivityFrequent (30-79%)
HP:0002293Alopecia of scalpOccasional (5-29%)
HP:0012531PainOccasional (5-29%)
HP:0030351Urticarial plaqueVery rare (<1-4%)

Identifiers

Disease identifiers

FieldValue
Canonical namepemphigus vulgaris
Mondo IDMONDO:0008219
EFOEFO:0004719
MeSHC536645
OMIM169610
Orphanet704
DOIDDOID:0060851
ICD-10-CML10.0
ICD-11278358681
NCITC34910
SNOMED CT49420001
UMLSC0030809
MedGen10621
GARD0007355
MedDRA10052802
Is cancer (heuristic)no

Data availability: 11 GWAS associations (4 studies) · 18 cell lines.

Disease family

An umbrella term covering 1 Mondo subtype.

Classification path: disease › human disease › disease by body system or component › integumentary system disorder › skin disorderdermatitis › autoimmune bullous skin disease › pemphiguspemphigus vulgaris

Related subtypes (5): pemphigoid gestationis, Hailey-Hailey disease, herpetiform pemphigus, pemphigus erythematosus, pemphigus foliaceus

Subtypes (1): pemphigus vegetans

Genetics & variants

GWAS landscape

11 GWAS associations across 4 studies. Top hits map to 3 distinct genes (as reported by GWAS).

Top associations by p-value

rsIDp-valueGeneRisk alleleOdds ratio
rs709939001e-45HLA-DRB1 - HLA-DQA1?18.57
HLA-DRB1*14:042e-38?6.28
rs284836333e-35HLA-DQA1 - HLA-DQB1?5.86
rs94692204e-19HLA-DQB1 - MTCO3P1G3.36
rs74541083e-12MTCO3P1 - HLA-DQB3?3.25
rs112187083e-08RNU6-592P - GLULP3A1.54
rs10745321e-06EPHA5-AS1 - RNU2-40PA1.81
rs1178147922e-06LINC02161 - MIR3660A3.12
rs10513363e-06HLA-DRA?3.03
rs92621225e-06PPP1R10?2.73
rs168378538e-06THSD7BG2

Top studies (by case count)

StudyLead authorYearCasesControlsTitle
GCST008068Zhang S20182550Subtype-Specific Inherited Predisposition to Pemphigus in Chinese Population.
GCST006584Gao J20182401,031Association study and fine-mapping major histocompatibility complex analysis of pemphigus vulgaris in a Han Chinese population.
GCST006521Sun Y20181010Investigation of the Predisposing Factor of Pemphigus and its clinical subtype through a Genome-wide association and next generation sequence analysis.
GCST001452Sarig O20121000Population-specific association between a polymorphic variant in ST18, encoding a pro-apoptotic molecule, and pemphigus vulgaris.

Variant details and genetic-evidence tiers

Tier distribution (top 50 variants)

TierVariants
Tier 1: coding0
Tier 2: splice/UTR1
Tier 3: regulatory2
Tier 4: intronic/intergenic8

MAF distribution

BucketVariants
common (>=0.05)9
low_freq (0.01-0.05)0
rare (<0.01)0
unknown2

Functional consequences

ConsequenceCount
intergenic_variant4
intron_variant3
unknown1
TF_binding_site_variant1
regulatory_region_variant1
3_prime_UTR_variant1

Top variants

rsIDChrPosAllelesMAFConsequenceGenep-valueTier
rs70993900632618381AC>A,ACC0.09intergenic_variantHLA-DRB1 - HLA-DQA11e-45Tier 4: intronic/intergenic
HLA-DRB1*14:042e-38Tier 4: intronic/intergenic
rs28483633632657097C>A0.05TF_binding_site_variantHLA-DQA1 - HLA-DQB13e-35Tier 3: regulatory
rs9469220632690533G>A,T0.33intergenic_variantHLA-DQB1 - MTCO3P14e-19Tier 4: intronic/intergenic
rs7454108632713706T>C0.05intergenic_variantMTCO3P1 - HLA-DQB33e-12Tier 4: intronic/intergenic
rs1121870811122601355G>A0.21regulatory_region_variantRNU6-592P - GLULP33e-08Tier 3: regulatory
rs1074532465791342A>C,G0.05intergenic_variantEPHA5-AS1 - RNU2-40P1e-06Tier 4: intronic/intergenic
rs117814792590014044G>Aintron_variantLINC02161 - MIR36602e-06Tier 4: intronic/intergenic
rs1051336632444815G>A,C0.053_prime_UTR_variantHLA-DRA3e-06Tier 2: splice/UTR
rs9262122630606065T>C0.05intron_variantPPP1R105e-06Tier 4: intronic/intergenic
rs168378532137014290A>C,G0.05intron_variantTHSD7B8e-06Tier 4: intronic/intergenic

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 0 · Orphanet: 14 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 0

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
HLA-DRB1Orphanet:2073Narcolepsy type 1
HLA-DRB1Orphanet:220393Diffuse cutaneous systemic sclerosis
HLA-DRB1Orphanet:220402Limited cutaneous systemic sclerosis
HLA-DRB1Orphanet:220407Limited systemic sclerosis
HLA-DRB1Orphanet:3437Vogt-Koyanagi-Harada disease
HLA-DRB1Orphanet:397Giant cell arteritis
HLA-DRB1Orphanet:477738Pediatric multiple sclerosis
HLA-DRB1Orphanet:536Systemic lupus erythematosus
HLA-DRB1Orphanet:545Follicular lymphoma
HLA-DRB1Orphanet:703Bullous pemphigoid
HLA-DRB1Orphanet:747Autoimmune pulmonary alveolar proteinosis
HLA-DRB1Orphanet:797Sarcoidosis
HLA-DRB1Orphanet:83465Narcolepsy type 2
HLA-DRB1Orphanet:85414Systemic-onset juvenile idiopathic arthritis

Cohort genes → proteins

2 cohort genes, 2 distinct canonical proteins.

Evidence partition

SubsetGenes
gwas_only2

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
UBASH3BHGNC:29884ENSG00000154127Q8TF42Ubiquitin-associated and SH3 domain-containing protein Bgwas
HLA-DRB1HGNC:4948ENSG00000196126P01911HLA class II histocompatibility antigen, DRB1 beta chaingwas

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
UBASH3BUbiquitin-associated and SH3 domain-containing protein BInterferes with CBL-mediated down-regulation and degradation of receptor-type tyrosine kinases.
HLA-DRB1HLA class II histocompatibility antigen, DRB1 beta chainA beta chain of antigen-presenting major histocompatibility complex class II (MHCII) molecule.

Protein-family classification

Druggable: 2 · Difficult: 0 · Unknown: 0 · Druggable fraction: 1.0

Family distribution

Cohort families vs a genome-wide background (hypergeometric, BH-FDR; fold = observed/expected). Counts kept; sorted by enrichment, so the catch-all Other/Unknown bucket no longer leads.

FamilyGenesFoldFDR
Phosphatase142.0×0.047
Antibody/Immunoglobulin114.6×0.067

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
UBASH3BPhosphataseyesSH3_domain, UBA-like_sf, His_Pase_superF_clade-1
HLA-DRB1Antibody/ImmunoglobulinyesMHC_II_b_N, Ig/MHC_CS, Ig_C1-set

Expression context

Cohort genes with no expression data: 0.

2 cohort genes are a single-cell marker in ≥1 SCXA experiment.

Breadth distribution (Bgee present_calls)

BucketGenes
narrow (1-5 tissues)0
moderate (6-20)0
broad (>20)2
unknown0

Top tissues across cohort

TissueCohort genes
cerebellar cortex1
cerebellum1
pons1
granulocyte1
right lung1
vermiform appendix1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
UBASH3B212ubiquitousmarkerpons, cerebellum, cerebellar cortex
HLA-DRB1131tissue_specificmarkervermiform appendix, granulocyte, right lung

Protein interactions among cohort

Intra-cohort edges: 0.

Hub genes (top 10 by interactor count)

SymbolInteractor count
HLA-DRB13,448
UBASH3B1,820

Structural data

PDB: 2 · AlphaFold-only: 0 · No structure: 0

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
HLA-DRB1P01911108
UBASH3BQ8TF426

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 7. Enrichment computed across 2 evidence-associated genes (1 with Reactome annotation).

Pathways by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 1 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
Translocation of ZAP-70 to Immunological synapse1634.4×0.004HLA-DRB1
Phosphorylation of CD3 and TCR zeta chains1543.8×0.004HLA-DRB1
Co-inhibition by PD-11519.1×0.004HLA-DRB1
Generation of second messenger molecules1346.1×0.005HLA-DRB1
Downstream TCR signaling1128.3×0.009HLA-DRB1
Interferon gamma signaling1125.5×0.009HLA-DRB1
MHC class II antigen presentation189.2×0.011HLA-DRB1

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 2 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
regulation of interleukin-4 production18426.0×0.003HLA-DRB1
antigen processing and presentation of endogenous peptide antigen via MHC class II14213.0×0.003HLA-DRB1
regulation of interleukin-10 production14213.0×0.003HLA-DRB1
myeloid dendritic cell antigen processing and presentation12808.7×0.003HLA-DRB1
regulation of T-helper cell differentiation12106.5×0.003HLA-DRB1
positive regulation of CD4-positive, alpha-beta T cell activation12106.5×0.003HLA-DRB1
positive regulation of CD4-positive, CD25-positive, alpha-beta regulatory T cell differentiation11685.2×0.003HLA-DRB1
positive regulation of T cell mediated immune response to tumor cell11203.7×0.004HLA-DRB1
T-helper 1 type immune response1936.2×0.004HLA-DRB1
positive regulation of memory T cell differentiation1936.2×0.004HLA-DRB1
positive regulation of monocyte differentiation1766.0×0.004HLA-DRB1
regulation of osteoclast differentiation1766.0×0.004UBASH3B
detection of bacterium1702.2×0.004HLA-DRB1
negative regulation of platelet aggregation1702.2×0.004UBASH3B
collagen-activated tyrosine kinase receptor signaling pathway1648.1×0.004UBASH3B
peptide antigen assembly with MHC class II protein complex1526.6×0.004HLA-DRB1
negative regulation of bone resorption1495.6×0.004UBASH3B
inflammatory response to antigenic stimulus1468.1×0.004HLA-DRB1
regulation of release of sequestered calcium ion into cytosol1468.1×0.004UBASH3B
protein tetramerization1312.1×0.006HLA-DRB1
negative regulation of inflammatory response to antigenic stimulus1300.9×0.006HLA-DRB1
antigen processing and presentation of exogenous peptide antigen via MHC class II1271.8×0.006HLA-DRB1
negative regulation of osteoclast differentiation1271.8×0.006UBASH3B
positive regulation of T cell mediated cytotoxicity1255.3×0.006HLA-DRB1
positive regulation of immune response1240.7×0.006HLA-DRB1
macrophage differentiation1234.1×0.006HLA-DRB1
positive regulation of T cell activation1221.7×0.006HLA-DRB1
negative regulation of type II interferon production1191.5×0.007HLA-DRB1
negative regulation of signal transduction1187.2×0.007UBASH3B
positive regulation of insulin secretion involved in cellular response to glucose stimulus1187.2×0.007HLA-DRB1

Therapeutics

Drugs indicated for this disease

3 approved, 4 in late-stage (phase 3) trials. Disease-direct ChEMBL indications, not inferred from the associated-gene cohort below.

DrugDevelopment status
DexamethasoneApproved (phase 4)
PrednisoneApproved (phase 4)
RituximabApproved (phase 4)
Mycophenolate MofetilPhase 3 (in late-stage trials)
OfatumumabPhase 3 (in late-stage trials)
RilzabrutinibPhase 3 (in late-stage trials)
Triamcinolone AcetonidePhase 3 (in late-stage trials)

Earlier-phase candidates (phase 2, investigational — efficacy not yet established): Azathioprine, Dapsone, Etanercept, Human Immunoglobulin G, Ianalumab, Parsaclisib.

Drug target analysis

Approved (phase 4): 0 · Phase ≥3: 1 · Phased (≥1): 1 · Undrugged: 1

Druggability breadth: 2 of 2 evidence-associated genes (100%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Top cohort targets by molecule count

SymbolMoleculesMax phase
UBASH3B13
HLA-DRB100

Drugs targeting cohort genes (top 30)

MoleculeMax phaseTargets in cohort
REBAMIPIDE3UBASH3B

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 0.

Cohort genes with ChEMBL bioactivity (full, sorted by assay count)

SymbolAssaysType breakdown
HLA-DRB117Binding:17
UBASH3B10Binding:10

Pharmacogenomics

Cohort genes with a PharmGKB record: 2; with CPIC/DPWG dosing guidelines: 0.

No cohort gene has a CPIC/DPWG genotype-guided dosing guideline (PharmGKB).

Chemical tractability of cohort targets

1 approved/phased compounds have measured bioactivity against a cohort gene (and aren’t yet in disease-level trials). This is a research / tractability signal, NOT a therapeutic recommendation — a bioactivity row often reflects off-target or screening binding (e.g. promiscuous kinase inhibitors against a cohort kinase), implying no disease mechanism.

CompoundMax phaseCohort target (bioactivity)
REBAMIPIDE3UBASH3B

Druggability pyramid

Cohort genes binned by druggability tier (high → low):

TierDefinitionGenesSymbols
AApproved (phase 4 drug)0
BPhased (≥1) drug, not yet approved1UBASH3B
CDruggable family + PDB, no drug1HLA-DRB1
DDruggable family + AlphaFold only, no drug0
EDifficult family or no structure, no drug0

Undrugged target profiles

1 cohort genes are undrugged. Ranked by ‘starting-point quality’ (assay depth + drugged-partner adjacency).

SymbolChEMBL assaysDrugged partners (top 3)
HLA-DRB117

Clinical trials & evidence

Clinical trials

Clinical trials: 39.

Phase distribution (across all retrieved trials)

PhaseTrials
PHASE213
Not specified12
PHASE36
PHASE1/PHASE23
PHASE13
PHASE42

Top trials by phase / activity

NCTPhaseStatusTitle
NCT05303272PHASE4UNKNOWNA Study to Evaluate Efficacy and Safety of Abatacept in Participants of Pemphigus Vulgaris (PV)
NCT06846255PHASE4COMPLETEDComparing DCP and DAP for Pemphigus Vulgaris
NCT00683930PHASE3COMPLETEDA Study to Assess the Effect of CellCept (Mycophenolate Mofetil) and Reduced Corticosteroids in Patients With Active Pemphigus Vulgaris (PV)
NCT01920477PHASE3TERMINATEDEfficacy and Safety of Ofatumumab in Treatment of Pemphigus Vulgaris
NCT02383589PHASE3COMPLETEDA Study to Evaluate the Efficacy and Safety of Rituximab Versus Mycophenolate Mofetil (MMF) in Participants With Pemphigus Vulgaris (PV)
NCT04598451PHASE3COMPLETEDA Study to Assess the Efficacy and Safety of a Subcutaneous Formulation of Efgartigimod PH20 SC in Adults With Pemphigus (Vulgaris or Foliaceus)
NCT04598477PHASE3TERMINATEDA Study to Assess the Long-term Safety and Efficacy of a Subcutaneous Formulation of Efgartigimod PH20 SC in Adults With Pemphigus (Vulgaris or Foliaceus)
NCT05594472PHASE3UNKNOWNOzonated Olive Oil in Treatment of Pemphigus Vulgaris and Bullous Pemphigoid
NCT04422912PHASE1/PHASE2RECRUITINGA Phase 1/2, Open-label, Safety and Dosing Study of Autologous CART Cells (Desmoglein 3 Chimeric Autoantibody Receptor T Cells [DSG3-CAART] or CD19-specific Chimeric Antigen Receptor T Cells [CABA-201]) in Subjects With Active, Pemphigus Vulgaris (RESET-PV)
NCT06663943PHASE1/PHASE2NOT_YET_RECRUITINGA Randomized Study on Pemphigus Treatment With Humanized CD38 Antibody CM313.
NCT00135720PHASE2COMPLETEDStudy of Etanercept (Enbrel) in the Treatment of Pemphigus Vulgaris
NCT00429533PHASE2TERMINATEDEfficacy of Dapsone as a Steroid Sparing Agent in Pemphigus Vulgaris
NCT00483119PHASE2TERMINATEDRandomized Trial of IVIg With or Without Cyclophosphamide in Pemphigus
NCT00606749PHASE2COMPLETEDUse of KC706 for the Treatment of Pemphigus Vulgaris
NCT00626678PHASE2COMPLETEDAzathioprine Versus Placebo in Pemphigus Vulgaris Treated With Prednisolone
NCT01930175PHASE2TERMINATEDStudy of Efficacy and Safety of VAY736 in Patients With Pemphigus Vulgaris
NCT02704429PHASE2COMPLETEDA Study of PRN1008 in Adult Patients With Pemphigus Vulgaris
NCT03075904PHASE1/PHASE2TERMINATEDA Safety and Dose-Finding Study of SYNT001 in Subjects With Pemphigus (Vulgaris or Foliaceus)
NCT03334058PHASE2COMPLETEDA Study to Evaluate the Safety, PD, PK and Efficacy of ARGX-113 in Patients With Pemphigus
NCT03780166PHASE2WITHDRAWNA Study of the Safety and Tolerability of INCB050465 in Pemphigus Vulgaris
NCT04023149PHASE2UNKNOWNEfficacy of Interleukin-2 Gargle in the Treatment of Oral Mucosa Lesion in Pemphigus Vulgaris
NCT04540133PHASE2COMPLETEDDexamethasone Solution and Dexamethasone in Mucolox™
NCT05000216PHASE2TERMINATEDCOVID-19 Booster Vaccine in Autoimmune Disease Non-Responders
NCT07461103PHASE2COMPLETEDEffect of Topical Insulin on Healing Rate of Pemphigus Lesions
NCT06581562PHASE1RECRUITINGOpen-label Single-Center Study to Evaluate the Safety and Efficacy of Combining Rituximab and AB-101 in B-cell Associated Autoimmune Diseases.
NCT00063752PHASE1COMPLETEDSafety Study of PI-0824 to Treat Pemphigus Vulgaris
NCT03239470PHASE1TERMINATEDPolyclonal Regulatory T Cells (PolyTregs) for Pemphigus
NCT02753777Not specifiedRECRUITINGAutoimmune Blistering Diseases Study
NCT05635266Not specifiedRECRUITINGTissue Repository Providing Annotated Biospecimens for Approved Investigator-directed Biomedical Research Initiatives
NCT06863454Not specifiedNOT_YET_RECRUITINGTrichoscopy as a Monitoring Tool for Activity and Remission in Pemphigus Vulgaris: A Clinical Study Supported by Immunological Evaluation.
NCT06971172Not specifiedNOT_YET_RECRUITINGLow-level Laser Therapy on Oral Pemphigus Vulgaris Patients.
NCT07384221Not specifiedRECRUITINGPeriodontal Status and Disease Severity in Pemphigus Vulgaris Patients
NCT03177213Not specifiedUNKNOWNSerum IL-21 Levels in Patients With Pemphigus Vulgaris
NCT04096222Not specifiedUNKNOWNComparative Analysis of the Th17 Cellular Response in Active and Inactive Pemphigus Vulgaris Patients
NCT04117529Not specifiedUNKNOWNPhenotypic and Functional Characterisation of Human B-cell Response in Pemphigus
NCT05338112Not specifiedUNKNOWNRole of Tzanck Smear in Determining Pemphigus Vulgaris Disease Activity
NCT06167408Not specifiedCOMPLETEDIdentifying Factors Influencing In-Hospital Relapse in Pemphigus Patients
NCT06654817Not specifiedCOMPLETEDEfficacy and Safety Evaluation of Anti-CD20 Monoclonal Antibody Combined with Azathioprine and Corticosteroids in the Treatment of Pemphigus Vulgaris
NCT07428915Not specifiedCOMPLETEDEvaluating Legit.Health Plus Support for Improving Diagnosis of Generalized Pustular Psoriasis and Other Skin Conditions Among Primary Care Physicians and Dermatologists

Drugs tested across these trials (top 30)

MoleculeMax phaseTrials referencing
EFGARTIGIMOD ALFA43
MYCOPHENOLATE MOFETIL42
AZATHIOPRINE41
DAPSONE41
ELASOMERAN41
GENTAMICIN SULFATE41
OFATUMUMAB41
TOZINAMERAN41
IANALUMAB31
PARSACLISIB31
RILZABRUTINIB31
AB-10121
ITX-506121
LUMROTATUG21
ORILANOLIMAB21
PI-082411