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Patients With Pemphigus Vulgaris Given Rituximab did not Experience More Severe COVID-19


Total dose and number of cycles of rituximab were not associated with duration or severity of COVID-19 disease.

Investigators conducted a retrospective study on adults with pemphigus vulgaris (PV) and a history of COVID-19 to determine if the biologic rituximab (RTX) had an effect on prognosis. Their findings showed that use of rituximab was safe and did not increase the risk of a more severe form of COVID-19 in patients with PV.1



The study included 36 patients 18 years old or older with PV and COVID-19 with or without symptoms who were treated with RTX in the 6 months since their COVID-19 infection. Patients seen from January 2020 to December 2020 were included. Mean age of patients was 48.43 years and 47.2% were male. All patients were given prednisolone in combination with RTX.

In 31 cases, COVID-19 infection was confirmed with positive RT-PCR tests. The other 5 cases were suspected of having COVID-19 based on symptoms including fever, chills, headache and myalgia, cough, and dyspnea.

The duration of COVID-19 symptoms did not vary greatly between patients receiving more than 2000 mg of RTX and those receiving less than 2000 mg of RTX in total (8.3 days vs 9.9 days, P = .23).

More than half of the patients (55.8%) were given O2 therapy. Nineteen patients were hospitalized for COVID-19 infection and 17 received remdesivir. No patients were admitted to ICU and the mean hospital stay was 3.26 days. One patient died from COVID-19 infection due to severe thrombocytopenia after chemotherapy for esophageal squamous cell carcinoma.

Aryanian et al noted “[G]ender, 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).”

None of the patients experienced multiple COVID-19 infections, and the majority did not develop changes in their PV regarding clinical phenotype (100%) or severity (83.3%). In the 6 patients with worsened PV, disease was managed with increasing prednisolone dosage.

Aryanian et al concluded “In this study, we found no increased risk of a severe form of COVID-19 in pemphigus patients receiving rituximab. Nevertheless, taking caution seems to be the most reasonable strategy and this therapeutic agent should only be administered to those patients with critical conditions like severe pemphigus vulgaris.”


  1. Aryanian Z, Balighi K, Sajad B, et al. COVID outcome in pemphigus: Does rituximab make pemphigus patients susceptible to more severe COVID-19? J Cosmet Dermatol. 2023; 00: 1-9. doi:10.1111/jocd.15958
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