Rituximab as the treatment of pemphigus vulgaris in the COVID-19 pandemic era: A narrative review.

Pemphigus vulgaris (PV), 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 coronavirus disease (COVID-19) pandemic. With this background, our objective was to review the currently available literature as well as important websites for the evidence related to rituximab, PV and COVID-19, adverse effects associated with drugs, and relevant guidelines. "PubMed" and "Google Scholar" database were systematically searched for retrieving all articles related to anti-CD20 therapy in pemphigus vulgaris and COVID-19 published up to 14 July 2020. A total of seven clinical studies are performed with anti-CD20 therapy in COVID-19, three of which are performed on pemphigus patients, and have shown concerns employing rituximab in patients with COVID-19. Evidence for treating PV patients with rituximab in COVID-19 pandemic is limited. Until sufficient evidence or guideline for pemphigus and COVID-19 treatment is available, we advocate caution commencing rituximab in patients with pemphigus, due to the reported adverse outcomes.