Rituximab exhibits a better safety profile when used as a first line of treatment for pemphigus vulgaris: A retrospective study

• Published in: International immunopharmacology 2021-07, Vol.96, p.107755-107755, Article 107755
• Main Authors: Aryanian, Zeinab, Balighi, Kamran, Daneshpazhooh, Maryam, Karamshahi, Emad, Hatami, Parvaneh, Goodarzi, Azadeh, Tajalli, Mahroo, Vance, Terrence M.
• Format: Article
• Language: English
• Subjects: Adverse effects; Autoimmune bullous disease; Autoimmune diseases; Comorbidity; Complications; First line treatment; Health risks; Patients; Pemphigus; Pemphigus vulgaris; Phenotypes; Remission; Rituximab; Side effects; Smoking
• ISSN: 1567-5769; 1878-1705
• DOI: 10.1016/j.intimp.2021.107755

•Pemphigus is an autoimmune serious and disabling disease.•Rituximab (RTX) recently has become a first-line treatment in newest guidelines.•We found some risk factors associated with developing infectious complications.•Receiving RTX after immunosuppressants was associated with more risk of infection.•Pemphigus patients benefit maximally from taking rituximab as first-line therapy. Pemphigus is an autoimmune disease that is challenging to treat and has few available therapeutic options. Recently, several studies have demonstrated that rituximab may be an efficacious first-line treatment in newest guidelines. To compare the side effect profiles of rituximab administered after a course of immunosuppressant agents versus as a first-line therapy and evaluate the impact of patient characteristics and disease severity indices on occurrence of adverse effects. A retrospective cross-sectional study was conducted on 999 patients with pemphigus vulgaris who received rituximab either as a first-line treatment or after conventional adjuvant therapies. The occurrence of partial or complete remission as well as the incidence of drug-related adverse effects were evaluated and compared between the two groups. Smoking, pulmonary comorbidity, and mucocutaneous phenotype were associated with an increased risk of developing infectious complications by 12.49, 5.79, and 2.37 fold, respectively. These associations were more prominent among those who received rituximab after immunosuppressant agents. Early use of rituximab benefits pemphigus patients, especially those with a mucocutaneous phenotype, pulmonary comorbidity, or history of smoking, and reduces their risk of infectious adverse events.