Rituximab yields cardiometabolic protection in pemphigus patients

Treatment with rituximab appears to confer protective effects against long-term cardiovascular and metabolic outcomes in patients with pemphigus as compared with conventional immunosuppressants, according to a study.

The population-based retrospective cohort study drew data from the Global Collaborative Network of TriNetX platform. It involved 961 pemphigus patients who were treated with rituximab and a similar number of patients who received azathioprine or mycophenolate mofetil (MMF; n=961). These patients were propensity-score matched to optimize comparability.

The primary endpoint was the risk of several cardiovascular and metabolic outcomes, namely myocardial infarction, stroke, peripheral vascular disease, pulmonary embolism, hypertension, hyperlipidaemia, type 2 diabetes, obesity, osteoporosis, and avascular bone necrosis.

In the cohort, 855 (53.4 percent) were women; the mean age was 54.8 years in the rituximab group and 54.4 years in the azathioprine/MMF group.

Multivariable analysis revealed that compared with azathioprine/MMF, rituximab was associated with a lower risk of myocardial infarction (relative risk [RR], 0.45, 95 percent confidence interval [CI], 0.24–0.86; p=0.01), stroke (RR, 0.42, 95 percent CI, 0.26–0.69; p<0.001), peripheral vascular disease (RR, 0.47, 95 percent CI, 0.28–0.79; p=0.003), hypertension (RR, 0.48, 95 percent CI, 0.38–0.63; p<0.001), hyperlipidaemia (RR, 0.45, 95 percent CI, 0.32–0.64; p<0.001), type 2 diabetes (RR, 0.63, 95 percent CI, 0.51–0.77; p<0.001), obesity (RR, 0.49, 95 percent CI, 0.34–0.72; p<0.001), and osteoporosis (RR, 0.46, 95 percent CI, 0.30–0.71; p<0.001).

Meanwhile, there was no between-group difference noted for all-cause mortality (hazard ratio, 0.94, 95 percent CI, 0.62–1.43; log-rank p=0.77).

The findings indicate that rituximab might be preferable for patients with pre-existing cardiovascular and metabolic risk factors.