Characteristics and outcomes of COVID-19 in patients with autoimmune bullous diseases: A retrospective cohort study

Mahmoudi, Hamidreza; Farid, Ali Salehi; Nili, Ali; Dayani, Dorsa; Tavakolpour, Soheil; Soori, Tahereh; Teimourpour, Amir; Isazade, Ahdie; Abedini, Robabeh; Balighi, Kamran; Daneshpazhooh, Maryam

doi:10.1016/j.jaad.2020.12.043

Cited by 30 publications

(59 citation statements)

References 3 publications

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“…However, the cited systematic review from Kasperkiewicz and coworkers did not include pemphigus patients treated with RTX shortly before infection as in our patient (33). In contrast, in line with our findings Mahmoudi et al found that in 13 patients with AIBDs who contracted COVID-19 after receiving RTX during the preceding 6 months, the risk of hospitalization decreased each month after RTX (13).…”

Section: Discussionsupporting

confidence: 76%

“…In conclusion, in our patient with a RTX-induced B cell d e p l e t i o n a n d i nfl a m m a t o r y-i n d u c e d l u n g i n j u r y, methylprednisolone treatment controlled the inflammatory phase, resulting in sudden clinical improvement. In addition, as suggested by Mahmoudi and coworkers, in our patient RTXinduced B cell depletion might be a risk factor for exacerbation of COVID-19 (13). Thus, as data are still scarce and as patients treated with anti-CD20 drugs are in general at higher risk for infections, the use of RTX during the pandemic has to be carefully pondered on a case-by-case basis (2,7).…”

Section: Discussionmentioning

confidence: 63%

“…Pemphigus patients can have a higher risk of infection due to exposed lesions and immunosuppressive treatments. As it is a rare disease, at present few cases of COVID-19 in RTX-treated pemphigus patients have been reported (7,13). To our knowledge this is the first detailed case of severe COVID-19 in a pemphigus patient treated with RTX shortly before infection with a complete B cell depletion.…”

Section: Discussionmentioning

confidence: 82%

“…Recently, Mahmoudi et al reported 21 COVID-19 cases from a cohort of patients with AIBDs. Thirteen of them received RTX in the previous six months, but no specific information was provided about the temporal distance of COVID-19 infections from RTX and B cell counts (13).…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Complete and Fast Recovery From Severe COVID-19 in a Pemphigus Patient Treated With Rituximab

et al. 2021

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COVID-19 is characterized by a severe pulmonary disease due to severe acute respiratory syndrome (SARS)-CoV-2 infection. For clinicians involved in the management of patients with chronic autoimmune diseases the risk linked to the conditions itself and to drug-induced immunosuppression during the COVID-19 pandemic is a major topic. Pemphigus is a rare autoimmune blistering disease (AIBD) of the skin and mucous membranes caused by autoantibodies to desmosomal components, desmoglein 1 and 3. Among immunosuppressant therapies, rituximab (RTX) is considered a highly effective treatment with a favorable safety profile, but it induces a prolonged B-cell depletion that can lead to higher susceptibility to infections. For this reason, concerns about its use during the pandemic have been raised. We describe a case of a pemphigus patient in which RTX-induced B cell depletion led to the severe inflammatory phase, whereas corticosteroid treatment allowed a favorable outcome.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Case Report: Complete and Fast Recovery From Severe COVID-19 in a Pemphigus Patient Treated With Rituximab

et al. 2021

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“…Last but not the least, we recommend the establishment of a national registry for AIBDs in order to build a network for monitoring patients’ needs all over the country and for responding promptly if health problems arise. In the time of COVID-19, the need for a registry is more crucial than ever before because it has been suggested that the immunomodulatory medications that patients with AIBDs receive may influence their risk of COVID-19 and hospitalization [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of autoimmune bullous diseases in Sudan between 2000 and 2016

et al. 2021

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Objectives Autoimmune bullous diseases vary in their clinico-epidemiological features and burden across populations. Data about these diseases was lacking in Sudan. We aimed to describe the epidemiological profile and to estimate the burden of autoimmune bullous diseases in Sudan. Methods This was a retrospective cross-sectional study conducted at Khartoum Dermatological and Venereal Diseases Teaching Hospital. We used routinely collected health care data, and included all patients with an autoimmune bullous disease who presented to the hospital between 2001 and 2016. Results Out of the 4736 patients who were admitted to the hospital during the study period, 923 (19.5%) had an autoimmune bullous disease. The average rate of patients at the hospital was 57.7 per year representing 1.3 per 100,000 population per year. After exclusion of patients where the final diagnosis was missing, 585 were included in the further analysis. Pemphigus vulgaris was the most common disease (50.9%), followed by bullous pemphigoid (28.2%), linear IgA disease/chronic bullous disease of childhood (8.4%), and pemphigus foliaceous (8.2%). Pemphigoid gestationis and IgA pemphigus constituted 1.4% and 1.2% of the cohort, respectively. Paraneoplastic pemphigus, mucous membrane pemphigoid, lichen planus pemphigoidis, bullous systemic lupus erythematosus, and dermatitis herpetiformis were rare. None of the patients had epidermolysis bullosa acquisita. Conclusions The clinico-epidemiological characteristics vary among the types of autoimmune bullous diseases. Females were more predominant in most of them. Sudanese patients tended in general to present at a younger age than other populations. The pool of Sudanese patients with autoimmune bullous diseases is large which requires investigation for the local risk factors and presents a field for future trials.

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Off-Label Uses of Rituximab in Dermatology

Cole

Amber

2022

Curr Derm Rep

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Purpose of Review Rituximab has transformed the treatment of B-cell malignancies and rheumatoid arthritis in the past 2 decades. More recently, this anti-CD20 monoclonal antibody has seen increasing usage in the field of dermatology. This review highlights the evidence supporting its use in several important dermatologic conditions. Recent Findings Key recent findings include the 2018 FDA approval of rituximab for the treatment of moderate-to-severe pemphigus. Summary Data from randomized controlled trials have demonstrated the efficacy of rituximab in pemphigus, ANCA-associated vasculitis, and cryoglobulinemic vasculitis. More limited data suggests its use in recalcitrant cases of diseases such as pemphigoid, epidermolysis bullosa acquisita, and dermatomyositis. There is scarce evidence and mixed results for rituximab when studied in cutaneous polyarteritis nodosa and cutaneous lupus erythematosus.

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Characteristics and outcomes of COVID-19 in patients with autoimmune bullous diseases: A retrospective cohort study

Cited by 30 publications

References 3 publications

Case Report: Complete and Fast Recovery From Severe COVID-19 in a Pemphigus Patient Treated With Rituximab

Case Report: Complete and Fast Recovery From Severe COVID-19 in a Pemphigus Patient Treated With Rituximab

The epidemiology of autoimmune bullous diseases in Sudan between 2000 and 2016

Off-Label Uses of Rituximab in Dermatology

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