عنوان

prevalence of early covid outcome in pemphigus patients receiving rituximab at razi hospital,شیوع کووید در بیماران پمفیگوس دریافت کننده ریتوکسیماب در بیمارستان رازی

98080P

انگلیسی

prevalence of early covid outcome in pemphigus patients receiving rituximab at razi hospital

شیوع کووید در بیماران پمفیگوس دریافت کننده ریتوکسیماب در بیمارستان رازی

[Dissertation]

Baseerat sajad

Tehran University of Medical Sciences, Faculty of Medicine

2022

97p

Doctor of Medicine(MD)

2022/06/06

Introduction: Pemphigus is a rare group of bullous autoimmune disease that affects skin and mucous membrane. In pemphigus, autoantibodies form against desmoglein, that attaches adjacent epidermal cells via attachment points called desmosomes. When autoantibodies attack desmoglein, the cells become separated from each other and the epidermis becomes detached, a phenomenon called acantholysis. Pemphigus, is a potentially life threatening autoimmune blistering disease, affecting the mucocutaneous surfaces It is caused by auto antibodies directed against desmoglein 1and desmoglein 3 adhesion molecules of epidermis . Pemphigus, an autoimmune blistering disease is treated with immunosuppressive medications. As the immunosuppressive effect of rituximab, the first-line therapy of PV, lasts more than 6 months, many concerns have raised due to the ongoing novel corona virus disease (COVID-19) pandemic. The effect of many of the drugs used for treatment of Pemphigus vulgaris (PV) on COVID-19 is not clear. We also do not have data on the impact of this autoimmune disease, which may involve the mucous membranes, on the acquisition or course of COVID-19. Method: This study is a cross sectional study which will examine if retuximab administration affected the course of covid 19 disease in patients with pemphigus vulgaris disease. Objectives taken into consideration are: type of pemphigus, disease ,age ,sex ,head and neck involvement ,lesion site, duration of disease ,follow up duration ,initial treatment administered ,infectious complications other than covid ,no of rituximab cycles ,duration of rituximab use, underlying disease,PDAI score ,prednisalone use , disease recurrence ,methotrexate use ,infectious complications associated with rituximab, skin complications due to covid, duration of quarantine, mortality associated with covid, prodrome symptoms, lower respiratory tract involvement, oxygen therapy used, admitted to hospital, duration of hospitalization, Remdesivir use, duration of respiratory symptoms, systemic involvement other than respiratory symptoms, admission to ICU , LDH levels, D-dimer levels, lung consolidation on CT scan checked in patients who adminsterated the retuximab in first six months of 1400. Data obtained was analyzed by SPSS software and the significance value of < 0.05% was considered.Results: In this study, 160 patients with Pemphigus Vulgaris were evaluated. The baseline characteristics of participants shown in table 1. Based on this table 47.5% of patients are male and 52.5% are female. The mean age of all patients in this study was 48.43 with standard deviation of 12.05. Among all participants, only 103 patients (64.4%) of them have follow-up. Nearly 138 of them (86.3%) get one course of Rituximab and almost 84.4% get ≤2000 mg of the drug. The percentage of side effect from the usage the Rituximab were reported in 12 (7.5%) of the patient and 69.4% did not have any side effect. About the PDAI mucosal involvement score, 146 (91.3%) are in moderate (0-15) category, 4 patient (2.5%) in significant category and no one in severe category. Also for the PDAI total activity score, 141(88.1%) of the patient are in moderate category (0-15), nine of them (5.6%) are significant (15-45) and no one in severe category. Among the all participant, only 62 of them (38.8%) have recurrence of pemphigus disease. Almost all the patient got Prednisalone in combination with Rituximab. The minimum dose of Prednisalone used was 2.5 mg and maximum dose was 60 mg, so the average dose of Prednisalone usage in total participant was 13.34 mg. Among all participant 84 of them (52.5%) have head and neck involvement. In Table 3, we seek to examine the effect of these variables on the consequences of COVID-19, which include covid symptoms reported in patients, so only those who tested positive or declared symptoms of Corona were examined. According to the table above, the frequency and percentage or mean of the variables in people with covid outcome and without covid outcome were compared. Among the studied variables, the patient's sex had a statistically significant effect on the cough (P-value = 0.03). Among those who had a cough, 37% were women and only 11% were men, i.e. the women suffered with this symptom more than males. Hence having severe course of disease. In addition, the patient's sex had a statistically significant effect on the frequency of gastrointestinal symptoms (GI-symptom) (P-value = 0.01) as 23.5% of women and only 12% of men had GI-symptom, i.e. the rate GI-symptom was more common in women. Also, recurrence of pemphigus disease had a statistically significant effect on the frequency of gastrointestinal symptoms (GI-symptom) (P-value = 0.04) so that among people with GI-symptom, 87.5% had no recurrence and only 12.5% had a recurrence of the disease, i.e. the rate of GI-symptom was higher in those who did not have a recurrence. There was a borderline statistical significant effect of LDH-level on Vertigo in patients infected with covid-19. No one with vertigo had a high LDH-level and not all patients with high LDH-level (three patients) had the vertigo.Conclusion: The scope of this study was to check the prevalence of early covid outcome in pemphigus patients receiving rituximab. In this study, 33 variables are taken into consideration to compare the effect of early covid outcome in pemphigus patients receiving rituximab. Conclusion of the results showed that long-term use of immune suppressive drugs could increase the severity of covid 19 symptoms in pemphigus patients. Symptoms of covid showed correlation with sex of the patient’s .The study suggests that the frequency of gastrointestinal symptoms tend to be more in females than in males. In addition, headache and myalgia symptoms are more severe in patients receiving long-term corticosteroids. There was borderline significant relationship between ldh, d-dimer levels and vertigo. As there are insufficient studies related to this topic, therefore results are inconclusive.

پمفیگوس ولگاریس یک بیماری تاولی خود ایمنی بالقوه تهدید کننده حیات است که پوست و مخاط را تحت تأثیر قرار می دهد و توسط اتوآنتی بادی هایی که علیه دسموگلین 1 و سه مولکول چسبنده دسموگلین اپیدرم ایجاد می شود ایجاد می شود. موارد شدید PV نشان دهنده یک اورژانس پزشکی واقعی است. از زمان اعلام عمومی شیوع COVID-19، نگرانی‌های متعددی از سوی متخصصان پوست و همچنین بیماران مبتلا به پمفیگوس که داروهای سرکوب‌کننده سیستم ایمنی مصرف می‌کنند، مطرح شده است. در این مقاله، ما ادبیات مربوط به درمان‌های رایج پمفیگوس را با تمرکز بر مطالعات قبلی از اپیدمی‌های مشابه مرور می‌کنیم تا پیشنهادی مناسب برای مدیریت پمفیگوس در دوران کووید-19 و کنترل مناسب بیماری با حداقل سرکوب سیستم ایمنی برای جلوگیری از پیامدهای کشنده احتمالی پیدا کنیم.

Pemphigus [1]

Covid 19 severity

Rituximab

, Author

, Author

sajad, Baseerat

سجاد، بصیرت

, Thesis advisor

, Thesis advisor

, Thesis advisor

, Thesis advisor

, Thesis advisor

, Thesis advisor

, Thesis advisor

, Thesis advisor

, Consulting advisor

, Consulting advisor

Aryanian, Zeinab

آریانیان، زینب

بلیغی، کامران

Balighi, Kamran

Esmailli, Nafise

اسماعیلی، نفیسه

Daneshpajooh, Maryam

دانش پژوه، مریم

مظلومی توتونچی، نسیم

Tootoonchi, Nasim Mazloomi

Tehran University of Medical Sciences, Faculty of Medicine

ایران

20220831

389 pardis

p

TL

276903

a

Y