The association of different therapeutic approaches with long-term cardiovascular and metabolic outcomes in patients with pemphigus still remains unclear.

The present study assessed the risk of long-term cardiovascular and metabolic outcomes and all-cause mortality in patients with pemphigus managed by rituximab, contrasting with those receiving treatment with first-line corticosteroid-sparing agents (azathioprine and mycophenolate mofetil [MMF]).

This global population–based retrospective cohort study compared 961 patients with pemphigus and managed with rituximab with other 961 treated with azathioprine or MMF concerning the risk of several cardiovascular and metabolic outcomes. 

It assessed the risk of myocardial infarction, stroke, peripheral vascular disease, pulmonary embolism, hypertension, hyperlipidemia, type 2 diabetes, obesity, osteoporosis, and avascular bone necrosis.

The study observed that-

• Among 1602 participants, 53.4% were women, and 46.6% were men.
• The mean (SD) age was 54.8 (16.6) years for those treated with rituximab and 54.4 (18.2) years for those treated with azathioprine or MMF. 
• Patients treated with rituximab experienced a lower risk of myocardial infarction, stroke, peripheral vascular disease, hypertension, hyperlipidemia, type 2 diabetes, obesity, and osteoporosis, than those treated by azathioprine/MMF.
• The all-cause mortality was comparable between the two groups.

This study shows that rituximab renders protection against long-term cardiovascular and metabolic outcomes more than conventional immunosuppressants. It might thus be helpful in individuals with preexisting cardiovascular and metabolic risk factors.

Kridin K, Mruwat N, Ludwig RJ. Association of Rituximab With Risk of Long-term Cardiovascular and Metabolic Outcomes in Patients With Pemphigus. JAMA Dermatol. 2023;159(1):56–61. doi:10.1001/jamadermatol.2022.5182