Kridin Khalaf, Mruwat Noor, Amber Kyle T, Ludwig Ralf J
Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Br J Dermatol. 2023 Mar 30;188(4):499-505. doi: 10.1093/bjd/ljac118.
The risk of infectious complications among patients with pemphigus managed by rituximab is yet to be precisely elucidated.
To evaluate the risk of infections in patients with pemphigus managed by rituximab vs. first-line corticosteroid-sparing agents [azathioprine and mycophenolate mofetil (MMF)].
A global population-based cohort study compared patients with pemphigus initiating rituximab (n = 963) vs. azathioprine or MMF (n = 963) regarding the risk of 26 different infections. Propensity score matching was conducted to optimize comparability.
During the initial 12 months following treatment, patients under rituximab experienced elevated risk of COVID-19 [hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.06-3.14; P = 0.028], parasitic diseases (HR 3.22, 95% CI 1.04-9.97; P = 0.032) and cytomegalovirus (CMV) infection (HR 1.63, 95% CI 1.04-2.58; P = 0.033). When evaluating infections developing ≥ 12 months after drug initiation, rituximab was associated with greater risk of pneumonia (HR 1.45, 95% CI 1.00-2.10; P = 0.047), COVID-19 (HR 1.87, 95% CI 1.49-2.33; P < 0.001), osteomyelitis (HR 2.42, 95% CI 1.11-5.31; P = 0.023), herpes simplex virus (HR 2.06, 95% CI 1.03-4.11; P = 0.037) and CMV (HR 1.63, 95% CI 1.07-2.49; P = 0.023) infections.
Within the first 12 months after treatment, patients under rituximab experience an elevated risk of COVID-19, parasitic and CMV infections. Rituximab is associated with pneumonia, osteomyelitis and viral diseases even beyond the first year after therapy. Pneumococcal vaccine and suppressive antiviral therapy should be considered even 1 year following therapy. There is no signal for elevated risk of tuberculosis, hepatitis B virus reactivation, Pneumocystis jiroveci pneumonia and progressive multifocal leukoencephalopathy.
利妥昔单抗治疗的天疱疮患者发生感染并发症的风险尚未得到确切阐明。
评估利妥昔单抗治疗的天疱疮患者与一线糖皮质激素节约剂（硫唑嘌呤和霉酚酸酯）相比的感染风险。
一项基于全球人群的队列研究比较了开始使用利妥昔单抗的天疱疮患者（n = 963）与使用硫唑嘌呤或霉酚酸酯的患者（n = 963）发生26种不同感染的风险。进行倾向评分匹配以优化可比性。
在治疗后的最初12个月内，接受利妥昔单抗治疗的患者发生2019冠状病毒病的风险升高[风险比（HR）1.82，95%置信区间（CI）1.06 - 3.14；P = 0.028]、寄生虫病（HR 3.22，95% CI 1.04 - 9.97；P = 0.032）和巨细胞病毒（CMV）感染（HR 1.63，95% CI 1.04 - 2.58；P = 0.033）。在评估药物开始使用≥12个月后发生的感染时，利妥昔单抗与肺炎风险增加相关（HR 1.45，95% CI 1.00 - 2.10；P = 0.047）、2019冠状病毒病（HR 1.87，95% CI 1.49 - 2.33；P < 0.001）、骨髓炎（HR 2.42，95% CI 1.11 - 5.31；P = 0.023）、单纯疱疹病毒感染（HR 2.06，95% CI 1.03 - 4.11；P = 0.037）和CMV感染（HR 1.63，95% CI 1.07 - 2.49；P = 0.023）。
在治疗后的前12个月内，接受利妥昔单抗治疗的患者发生2019冠状病毒病、寄生虫和CMV感染的风险升高。即使在治疗后第一年之后，利妥昔单抗仍与肺炎、骨髓炎和病毒感染相关。即使在治疗1年后也应考虑接种肺炎球菌疫苗和进行抗病毒抑制治疗。未发现结核病、乙型肝炎病毒再激活、耶氏肺孢子菌肺炎和进行性多灶性白质脑病风险升高的迹象。
