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

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Avcı C., Akın G. N., Akarsu S., Aktan Ş.

DERMATOLOGICA SINICA, vol.42, pp.31-38, 2024 (SCI-Expanded)

  • Publication Type: Article / Article
  • Volume: 42
  • Publication Date: 2024
  • Doi Number: 10.4103/ds.ds-d-23-00200
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, Directory of Open Access Journals
  • Page Numbers: pp.31-38
  • Dokuz Eylül University Affiliated: Yes


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.