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Aryanian Z, Balighi K, Sajad B, Esmaeli N, Daneshpazhooh M, Mazloumi Tootoonchi N, Beigmohammadi F, Mohseni Afshar Z, Hatami P. COVID outcome in pemphigus: Does rituximab make pemphigus patients susceptible to more severe COVID-19? J Cosmet Dermatol 2023; 22:2880-2888. [PMID: 37573477 DOI: 10.1111/jocd.15958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 06/11/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND The 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. OBJECTIVES To assess the reciprocal interaction of COVID-19 and pemphigus and the effect of rituximab on prognosis of COVID-19 in patients. METHODS We 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. RESULTS Thirty-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. CONCLUSION Rituximab appears to be safe with no increased risk of severe form of COVID-19 in patients with pemphigus vulgaris.
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Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, School of Medicine, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Baseerat Sajad
- Autoimmune Bullous Diseases Research Center, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Esmaeli
- Autoimmune Bullous Diseases Research Center, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, School of Medicine, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, School of Medicine, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Mazloumi Tootoonchi
- Autoimmune Bullous Diseases Research Center, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, School of Medicine, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Beigmohammadi
- Autoimmune Bullous Diseases Research Center, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
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Hatami P, Balighi K, Nicknam Asl H, Aryanian Z. 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. Dermatol Ther 2021; 35:e15216. [PMID: 34811862 PMCID: PMC9011959 DOI: 10.1111/dth.15216] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/19/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022]
Abstract
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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Affiliation(s)
- Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Nicknam Asl
- Department of Dentistry, Rafsanjan University of Medical Sciences (RUMS), Rafsanjan, Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
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