{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:16:20Z","timestamp":1791994580585,"version":"4.4.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"<jats:sec id=\"ab-doi220060-4\"><jats:title>Importance<\/jats:title><jats:p>The association of different therapeutic approaches with long-term cardiovascular and metabolic outcomes in patients with pemphigus remains to be precisely evaluated.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220060-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the risk of long-term cardiovascular and metabolic outcomes and all-cause mortality in patients with pemphigus managed by rituximab compared with those receiving treatment with first-line corticosteroid-sparing agents (azathioprine and mycophenolate mofetil [MMF]).<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220060-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A global population\u2013based retrospective cohort study compared 961 patients with pemphigus that was managed with rituximab with those treated with azathioprine or MMF (n\u2009=\u2009961) regarding the risk of several cardiovascular and metabolic outcomes. Propensity score matching was performed to optimize comparability. Patients were enrolled from the Global Collaborative Network of TriNetX platform.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220060-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Risk of myocardial infarction, stroke, peripheral vascular disease, pulmonary embolism, hypertension, hyperlipidemia, type 2 diabetes, obesity, osteoporosis, and avascular bone necrosis.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220060-8\"><jats:title>Results<\/jats:title><jats:p>Of 1602 participants, 855 (53.4%) were women and 747 (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. Compared with those treated by azathioprine\/MMF, patients treated with rituximab experienced a lower risk of myocardial infarction (relative risk [RR], 0.45; 95% CI, 0.24-0.86;<jats:italic>P<\/jats:italic>\u2009=\u2009.01), stroke (RR, 0.42; 95% CI, 0.26-0.69;<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), peripheral vascular disease (RR, 0.47; 95% CI, 0.28-0.79;<jats:italic>P<\/jats:italic>\u2009=\u2009.003), hypertension (RR, 0.48; 95% CI, 0.38-0.63;<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), hyperlipidemia (RR, 0.45; 95% CI, 0.32-0.64;<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), type 2 diabetes (RR, 0.63; 95% CI, 0.51-0.77;<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), obesity (RR, 0.49; 95% CI, 0.34-0.72;<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), and osteoporosis (RR, 0.46; 95% CI, 0.30-0.71;<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). The all-cause mortality was comparable between patients in both groups (hazard ratio, 0.94; 95% CI, 0.62-1.43; log-rank<jats:italic>P<\/jats:italic>\u2009=\u2009.77).<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220060-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The results of this cohort study suggest that rituximab was associated with protection against long-term cardiovascular and metabolic outcomes compared with conventional immunosuppressants. This agent might be particularly preferred in individuals with preexisting cardiovascular and metabolic risk factors.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2022.5182","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T16:33:27Z","timestamp":1669826007000},"page":"56","source":"Crossref","is-referenced-by-count":23,"title":["Association of Rituximab With Risk of Long-term Cardiovascular and Metabolic Outcomes in Patients With Pemphigus"],"prefix":"10.1001","volume":"159","author":[{"given":"Khalaf","family":"Kridin","sequence":"first","affiliation":[{"name":"L\u00fcbeck Institute of Experimental Dermatology, University of L\u00fcbeck, L\u00fcbeck, Germany"},{"name":"Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel"},{"name":"Unit of Dermatology and Skin Research Laboratory, Barch Padeh Medical Center, Poriya, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Mruwat","sequence":"additional","affiliation":[{"name":"Unit of Dermatology and Skin Research Laboratory, Barch Padeh Medical Center, Poriya, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf J.","family":"Ludwig","sequence":"additional","affiliation":[{"name":"L\u00fcbeck Institute of Experimental Dermatology, University of L\u00fcbeck, L\u00fcbeck, Germany"},{"name":"Department of Dermatology, University of L\u00fcbeck, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10201","key":"doi220060r1","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/S0140-6736(19)31778-7","article-title":"Pemphigus.","volume":"394","author":"Schmidt","year":"2019","journal-title":"Lancet"},{"issue":"1","key":"doi220060r2","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1056\/NEJM200007063430105","article-title":"Protection against pemphigus foliaceus by desmoglein 3 in neonates.","volume":"343","author":"Wu","year":"2000","journal-title":"N Engl J Med"},{"issue":"5","key":"doi220060r3","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1172\/JCI28547","article-title":"T cell control in autoimmune bullous skin disorders.","volume":"116","author":"Hertl","year":"2006","journal-title":"J Clin Invest"},{"issue":"5","key":"doi220060r4","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/0092-8674(91)90360-B","article-title":"Autoantibodies against a novel epithelial cadherin in pemphigus vulgaris, a disease of cell adhesion.","volume":"67","author":"Amagai","year":"1991","journal-title":"Cell"},{"issue":"5","key":"doi220060r5","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1172\/JCI114036","article-title":"Pemphigus and pemphigoid as paradigms of organ-specific, autoantibody-mediated diseases.","volume":"83","author":"Stanley","year":"1989","journal-title":"J Clin Invest"},{"issue":"2","key":"doi220060r6","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1001\/archderm.1996.03890260105016","article-title":"The adjuvant therapy of pemphigus: an update.","volume":"132","author":"Bystryn","year":"1996","journal-title":"Arch Dermatol"},{"issue":"9","key":"doi220060r7","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.2340\/00015555-2706","article-title":"Pemphigus vulgaris and pemphigus foliaceus: differences in epidemiology and mortality.","volume":"97","author":"Kridin","year":"2017","journal-title":"Acta Derm Venereol"},{"issue":"5","key":"doi220060r8","doi-asserted-by":"publisher","first-page":"607","DOI":"10.2340\/00015555-2611","article-title":"Mortality and cause of death in patients with pemphigus.","volume":"97","author":"Kridin","year":"2017","journal-title":"Acta Derm Venereol"},{"key":"doi220060r9","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.875492","article-title":"Unmet medical needs in chronic, non-communicable inflammatory skin diseases.","volume":"9","author":"Ujiie","year":"2022","journal-title":"Front Med (Lausanne)"},{"issue":"5","key":"doi220060r10","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1111\/bjd.2017.177.issue-5","article-title":"British Association of Dermatologists\u2019 guidelines for the management of pemphigus vulgaris 2017.","volume":"177","author":"Harman","year":"2017","journal-title":"Br J Dermatol"},{"issue":"3","key":"doi220060r11","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/j.jaad.2018.02.021","article-title":"Diagnosis and management of pemphigus: recommendations of an international panel of experts.","volume":"82","author":"Murrell","year":"2020","journal-title":"J Am Acad Dermatol"},{"issue":"3","key":"doi220060r12","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1111\/jdv.12772","article-title":"Pemphigus. 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