RITUXIMAB may prevent long-term comorbidities such as long-term cardiovascular and metabolic diseases, while leading to a similar survival rate, compared to other treatments for pemphigus. Pemphigus, which can be life-threatening, is an autoimmune bullous disease that leads to blisters and erosions in the mucosal surfaces and skin. While 1-year mortality rates in patients who receive proper treatment has dropped substantially, patients with pemphigus are more susceptible to death compared to the general population, explained Khalaf Kridin, Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany.
While the first-line therapy of this condition consists of systemic corticosteroids, adjuvant agents, including azathioprine and mycophenolate mofetil (MMF) have been introduced due to the adverse events linked to corticosteroids. A monoclonal chimeric mouse/human antibody that targets CD20-expressing B lymphocytes, rituximab, has been shown to be highly effective in the treatment of moderate to severe pemphigus, when combined with low-dose and short-term corticosteroids; however, data on long-term complications of this treatment is scarce.
Kridin and colleagues conducted a retrospective cohort study to evaluate the long-term cardiovascular and metabolic comorbidities as well as mortality rates of patients with pemphigus treated with ritixumab, compared to patients treated with azathioprine or MMF. The study included 1,602 patients, who underwent propensity score matching based on various comorbidities and demographic variables. Data showed that patients treated with rituximab experienced a lower risk of myocardial infarction, peripheral vascular disease, stroke, hyperlipidaemia, Type 2 diabetes, hypertension, obesity, and osteoporosis, compared to those treated with azathioprine or MMF. Risk of pulmonary embolism and mortality was similar in both groups.
Researchers concluded: “Rituximab was associated with significant protection against the development of several long-term cardiovascular and metabolic outcomes in pemphigus,” and that “the study results suggest that rituximab might be particularly preferred in individuals with cardiovascular and metabolic risk factors, for whom corticosteroid-related adverse events must be strictly avoided.”