Rituximab treatment for refractory and moderate-to-severe pemphigus patients in the pandemic era: A single-center retrospective study

Abstract

Abstract Background: The management of refractory pemphigus in the pandemic conditions is challenging. There are limited data comparing the safety of rituximab and other immunosuppressive therapies during the COVID-19 pandemic. Objectives: We evaluated the safety and efficacy of rituximab and conventional treatments in patients with pemphigus who received treatment during the COVID-19 pandemic period. Methods: The patients with pemphigus treated with immunosuppressive treatments in a university hospital between September 2020 and May 2023 were retrospectively evaluated. All patients initially received conventional treatments. Fifteen of them who were refractory to prior treatments or could not use prednisolone due to adverse effects received rituximab. Eighteen patients were treated with only conventional treatments. Results: Thirty-three patients with a mean age of 50 ± 15 years were included in the study. Twenty-two of the patients (66.7%) were female. The baseline mean pemphigus disease area index (PDAI) score of the patients was 37 ± 34 (range: 4–168). The mean follow-up time was 13.8 ± 6.8 months. The mean PDAI scores were significantly lower after treatment in both rituximab and conventional treatment groups (P: 0.001, P < 0.001; respectively). In the rituximab group, the monthly mean prednisolone dose was statistically reduced after rituximab treatment compared to before treatment (P < 0.001). There was no statistically significant difference in the relative odds of COVID-19 positivity or death between the groups (3.06 (95% [confidence interval (CI): 0.68–13.79]; 0.57 [95% CI: 0.05–7.00], respectively). Of 11 patients diagnosed with COVID-19, one patient (1/7, 14.3%) in the rituximab group and two patients (2/4, 50%) in the conventional treatment group died from SARS-CoV-2. Conclusion: We observed that rituximab treatment was effective and safe for treatment-resistant moderate-to-severe pemphigus patients during the COVID-19 pandemic.