{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:16:25Z","timestamp":1791994585079,"version":"4.4.0"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The risk of infectious complications among patients with pemphigus managed by rituximab is yet to be precisely elucidated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the risk of infections in patients with pemphigus managed by rituximab vs. first-line corticosteroid-sparing agents [azathioprine and mycophenolate mofetil (MMF)].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A global population-based cohort study compared patients with pemphigus initiating rituximab (n = 963) vs. azathioprine or MMF (n = 963) regarding the risk of 26 different infections. Propensity score matching was conducted to optimize comparability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the initial 12\u2005months following treatment, patients under rituximab experienced elevated risk of COVID-19 [hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.06\u20133.14; P = 0.028], parasitic diseases (HR 3.22, 95% CI 1.04\u20139.97; P = 0.032) and cytomegalovirus (CMV) infection (HR 1.63, 95% CI 1.04\u20132.58; P = 0.033). When evaluating infections developing \u2265 12\u2005months after drug initiation, rituximab was associated with greater risk of pneumonia (HR 1.45, 95% CI 1.00\u20132.10; P = 0.047), COVID-19 (HR 1.87, 95% CI 1.49\u20132.33; P &amp;lt; 0.001), osteomyelitis (HR 2.42, 95% CI 1.11\u20135.31; P = 0.023), herpes simplex virus (HR 2.06, 95% CI 1.03\u20134.11; P = 0.037) and CMV (HR 1.63, 95% CI 1.07\u20132.49; P = 0.023) infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Within the first 12\u2005months after treatment, patients under rituximab experience an elevated risk of COVID-19, parasitic and CMV infections. Rituximab is associated with pneumonia, osteomyelitis and viral diseases even beyond the first year after therapy. Pneumococcal vaccine and suppressive antiviral therapy should be considered even 1\u2005year following therapy. There is no signal for elevated risk of tuberculosis, hepatitis B virus reactivation, Pneumocystis jiroveci pneumonia and progressive multifocal leukoencephalopathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjd\/ljac118","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:46:30Z","timestamp":1673311590000},"page":"499-505","source":"Crossref","is-referenced-by-count":32,"title":["Risk of infections in patients with pemphigus treated with rituximab vs. azathioprine or mycophenolate mofetil: a large-scale global cohort study"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9971-9151","authenticated-orcid":false,"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":"Kyle T","family":"Amber","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Rush University Medical Center , Chicago, IL , USA"}],"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":"286","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"key":"2023100916153299600_ljac118-B1","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/S0140-6736(19)31778-7","article-title":"Pemphigus","volume":"394","author":"Schmidt","year":"2019","journal-title":"Lancet"},{"key":"2023100916153299600_ljac118-B2","doi-asserted-by":"crossref","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"},{"key":"2023100916153299600_ljac118-B3","doi-asserted-by":"crossref","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":"2023100916153299600_ljac118-B4","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1080\/14712598.2021.1874915","article-title":"The evolving role of rituximab in the treatment of pemphigus vulgaris: a comprehensive state-of-the-art review","volume":"21","author":"Kridin","year":"2021","journal-title":"Expert Opin Biol Ther"},{"key":"2023100916153299600_ljac118-B5","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1016\/S0140-6736(17)30070-3","article-title":"First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial","volume":"389","author":"Joly","year":"2017","journal-title":"Lancet"},{"key":"2023100916153299600_ljac118-B6","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1056\/NEJMoa2028564","article-title":"Rituximab versus mycophenolate mofetil in patients with pemphigus vulgaris","volume":"384","author":"Werth","year":"2021","journal-title":"N Engl J Med"},{"key":"2023100916153299600_ljac118-B7","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3348\/kjr.2015.16.2.286","article-title":"Propensity score matching: a conceptual review for radiology researchers","volume":"16","author":"Baek","year":"2015","journal-title":"Korean J Radiol"},{"key":"2023100916153299600_ljac118-B8","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1093\/ckj\/sfx038","article-title":"Infectious complications of rituximab therapy in renal disease","volume":"10","author":"Nixon","year":"2017","journal-title":"Clin Kidney J"},{"key":"2023100916153299600_ljac118-B9","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/jid.2011.249","article-title":"Incidence, mortality, and causes of death of patients with pemphigus in Taiwan: a nationwide population-based study","volume":"132","author":"Huang","year":"2012","journal-title":"J Invest Dermatol"},{"key":"2023100916153299600_ljac118-B10","doi-asserted-by":"crossref","first-page":"e2\u201316","DOI":"10.1016\/j.ijid.2010.03.025","article-title":"Does rituximab increase the incidence of infectious complications? 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