Estimating the susceptibility to SARS-CoV-2 infection with rituximab use for pemphigus vulgaris

Jafri, Zainab A; Walia, Shikha; Ivanic, Mirjana G; Wu, Jashin J.

doi:10.1080/09546634.2020.1870648

Cited by 3 publications

(5 citation statements)

References 4 publications

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“…7,8 However, the safety of RTX in the COVID era is still a controversial issue. In a review of two phase III trials of RTX, no increased susceptibility to respiratory infections including COVID-19 was reported in patients with pemphigus who received rituximab as their first-line treatment, 9 which was in line with Aryanian et al study which was earlier conducted. 2 Previous studies about the effect of RTX on immunological response following inactivated vaccines showed attenuated, yet meaningful response, 10 but there is not any similar study on live attenuated vaccines in the literature due to safety concerns of these vaccines in those receiving RTX.…”

Section: Discussionsupporting

confidence: 54%

“…However, the safety of RTX in the COVID era is still a controversial issue. In a review of two phase III trials of RTX, no increased susceptibility to respiratory infections including COVID‐19 was reported in patients with pemphigus who received rituximab as their first‐line treatment, 9 which was in line with Aryanian et al study which was earlier conducted 2…”

Section: Discussionmentioning

confidence: 57%

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COVID vaccination in patients under treatment with rituximab: A presentation of two cases from Iran and a review of the current knowledge with a specific focus on pemphigus

Hatami

Balighi

Asl

et al. 2021

Dermatologic Therapy

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SARS-COV2 vaccines were approved without long-term monitoring due to emergent situations. This has raised some issues about the timing and protocol of receiving vaccines in specific situations such as patients receiving immunomodulatory agents including rituximab, which is widely used for various disorders such as multiple sclerosis, pemphigus, and many rheumatologic disorders. We described two cases of pemphigus vulgaris (a new case and one with flare-up) following vaccination with Astrazeneca in Iran and reviewed the existing data in this regard through searching on PubMed, Google Scholar, and Scopus. All of the relevant papers published until June 28, 2021, which we could access their full-texts were included. We found some recommendations made by rheumatologists, neurologists, and dermatologists in regard to vaccination timing in this group of patients and tried to summarize them to provide a practical guide for clinicians.Clinicians should perform a careful, individualized risk-benefit assessment for their patients and consider a delay in rituximab administration after completion of COVID vaccination if there is not any considerable risk of disease relapse or organ failure. Moreover, choosing vaccines with potential of providing protection after single dose, especially in countries with limited access to vaccines may be a reasonable approach.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 57%

COVID vaccination in patients under treatment with rituximab: A presentation of two cases from Iran and a review of the current knowledge with a specific focus on pemphigus

Hatami

Balighi

Asl

et al. 2021

Dermatologic Therapy

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“…31 Furthermore, the use of cytokine inhibitors during the pandemic might be considered as a support for their non-harmful impact on the course of COVID-19. 30,[32][33][34] These reassuring findings of the use of new biologic therapeutics agents are congruent with our findings in patients…”

Section: Discussionsupporting

confidence: 89%

“…Thus, suppressing this over‐activation of immune system by the use of biologic agents would be resulted in a milder benign clinical course of disease 31 . Furthermore, the use of cytokine inhibitors during the pandemic might be considered as a support for their non‐harmful impact on the course of COVID‐19 30,32–34 . These reassuring findings of the use of new biologic therapeutics agents are congruent with our findings in patients with pemphigus who received rituximab.…”

Section: Discussionsupporting

confidence: 82%

COVID outcome in pemphigus: Does rituximab make pemphigus patients susceptible to more severe COVID‐19?

Aryanian,

Balighi,

Sajad

et al. 2023

J of Cosmetic Dermatology

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BackgroundThe COVID‐19 pandemic has raised some concerns regarding the management of chronic skin diseases, especially in patients on immunosuppressive therapy including patients with pemphigus vulgaris (PV). Literature review reveals conflicting results about the effect of monoclonal antibodies such as rituximab on clinical outcome of COVID‐19.ObjectivesTo assess the reciprocal interaction of COVID‐19 and pemphigus and the effect of rituximab on prognosis of COVID‐19 in patients.MethodsWe set up a retrospective study on adult patients with a confirmed diagnosis of pemphigus vulgaris and a history of COVID‐19 with or without symptoms during 2020.ResultsThirty‐six adults with pemphigus vulgaris and SARS‐CoV‐2 infection were included. The SARS‐CoV‐2 infection was confirmed with positive RT‐PCR test results in 31 cases (86.1%) and suspected in the 5 others (13.9%). Gender, total dose of rituximab, number of rituximab cycles, and involvement of head and neck were not associated to duration of COVID‐19 symptoms (p values: 0.32, 0.23, 0.84, and 0.51, respectively), severity of disease (hospitalization) (p values: 0.46, 0.39, 0.23, and 0.72, respectively), or the percentage of lung involvement on CT scan (p values: 0.07, 0.36, 0.38, and 0.09, respectively). Regarding the impact of COVID‐19 on pemphigus, the majority of patients did not experience any changes in their pemphigus regarding clinical phenotype (100%) or severity (83.3%), but PV was worsened in 6 (16.9%) patients which was controlled with increasing the prednisolone dosage.ConclusionRituximab appears to be safe with no increased risk of severe form of COVID‐19 in patients with pemphigus vulgaris.

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“…Our study showed in multivariate logistic regression model that other immunosuppressive agent treatment including azathioprine, methotrexate, mycophenolate mofetil, cyclophosphamide, ciclosporin and rituximab will not increase infection risk. Previous studies have also shown glucocorticoid with adjuvant immunosuppressive agents like rituximab did not increase infections in pemphigus and bullous pemphigoid patients, and even improved the disease remission (21)(22)(23)(24)(25). This gives the consideration of adding other immunosuppressive agents when using glucocorticoid to treat pemphigus or bullous pemphigoid, in order to reduce dose of glucocorticoid and thus lower risk of infection.…”

Section: Discussionmentioning

confidence: 89%

Various infections in patients with autoimmune bullous diseases: a retrospective case-control study

Zhou

Zheng

Yang

et al. 2023

Preprint

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Background:Infection will cause adverse outcomes in autoimmune bullous diseases (AIBD). We aimed to analyze pathogen spectrum and location characteristics of infection in AIBD, risk factors of infection and provide probable suggestion to infection prevention. Methods:This is a retrospective case-control study on medical records of inpatients diagnosed as AIBD in Huashan Hospital from 2017 to 2021. Results: A total of 263 patients diagnosed with AIBD were enrolled. Total infection rate was 42.2%. Infection rate was 52.1% in pemphigus and 30.6% in bullous pemphigoid.Of patients with infections, 49.5% had bacterial infections, 13.5% had fungal infections, 2.7% had virus infection and 34.2% had mixed infections. 17.1% patients had localized infections and 24.7% had systemic infections. The most common pathogens were Staphylococcus aureus and Candida in localized infection, and were Cryptococcusand Candida in systemic infection. In multivariate logistic model, pemphigus compared to bullous pemphigoid (OR=2.56, 95% CI 1.41-4.63), hypoalbuminemia (OR=3.78, 95% CI 1.68-8.50) and systemic glucocorticoids treatment (OR=4.67, 95% CI 2.51-8.68) were infection risk factors. Bullous pemphigoid compared to pemphigus (OR=3.99, 95% CI 1.03-15.45), high dose systemic glucocorticoids treatment compared to low (OR=19.31, 95% CI 3.32-112.28) or medium dose (OR=5.71, 95% CI 1.37-23.79) were risk factors of systemic infection in infected patients with systemic glucocorticoids treatments. Conclusions:Infection rate in AIBD patients was high. Pathogen spectrum and location of infection were broad. Systemic glucocorticoid treatment, especially with high dose in previous 3 months had been shown as an important risk factor of infection.

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Estimating the susceptibility to SARS-CoV-2 infection with rituximab use for pemphigus vulgaris

Cited by 3 publications

References 4 publications

COVID vaccination in patients under treatment with rituximab: A presentation of two cases from Iran and a review of the current knowledge with a specific focus on pemphigus

COVID vaccination in patients under treatment with rituximab: A presentation of two cases from Iran and a review of the current knowledge with a specific focus on pemphigus

COVID outcome in pemphigus: Does rituximab make pemphigus patients susceptible to more severe COVID‐19?

Various infections in patients with autoimmune bullous diseases: a retrospective case-control study

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