# Eight Years of Follow-Up of Rituximab in Pemphigus Vulgaris and Foliaceus at a Single Center: Assessing Efficacy and Safety in Light of Several Factors

## TL;DR

This study evaluated rituximab's long-term effectiveness and safety in treating pemphigus vulgaris and foliaceus over eight years, finding it highly effective for foliaceus and moderately effective for vulgaris.

## Contribution

The study provides long-term efficacy and safety data of rituximab in pemphigus patients over an 8-year period, including during the COVID-19 pandemic.

## Key findings

- Rituximab achieved long-lasting complete clinical remission in 83% of pemphigus foliaceus patients.
- Only 45.5% of pemphigus vulgaris patients achieved long-lasting remission with rituximab.
- The COVID-19 period did not negatively impact remission rates in treated patients.

## Abstract

Background/Objectives: Pemphigus vulgaris (PV) and foliaceus (PF) are autoimmune blistering diseases mediated by IgG antibodies directed against desmogleins 1 and 3 and are still considered life-threatening disorders. In recent years, rituximab has been shown to be very effective, especially in PV and mainly in short follow-ups. The role of rituximab in achieving long-lasting complete clinical remission (cCR) in pemphigus still needs to be determined. Therefore, the aim of our study was to assess the efficacy, measured by achieving long-lasting cCR, and safety of rituximab in both PV and PF over an 8-year follow-up in light of several factors (body mass index—BMI, severity of disease—PDAI, age, gender, disease duration, COVID-19 period). Methods: In total, 28 patients with pemphigus were treated with rituximab and followed-up at one center. The entire analysis was performed using statistical methods. Results: Long-lasting cCR was achieved in 5 out of 6 patients (83%) with PF and 10 of 22 (45.5%) patients with PV. Univariate and multivariate analysis disclosed that studied factors did not statistically correlated with achieving long-lasting cCR. Among studied patients, few developed side effects, mainly urinary tract infection; one patient had sepsis, and one patient died. Conclusions: This study has demonstrated that rituximab is highly effective in PF and quite effective in PV over an 8-year follow-up in relation to independently studied factors. Moreover, the COVID-19 pandemic was not a negative factor influencing cCR achievement since 82% of patients treated with rituximab during that time still achieved cCR.