Short-term prognostic factors of rituximab combined with glucocorticoids in the treatment of pemphigus: A multicenter retrospective study.

BACKGROUND: Rituximab (RTX) combined with glucocorticoids (GCs) is a first-line treatment for pemphigus, yet short-term prognostic outcomes and their predictors remain underexplored in Chinese populations. OBJECTIVE: To evaluate the 52-week outcomes of RTX combined with GCs in a real-world Chinese cohort and identify independent predictors of complete remission on minimal therapy (CR mini) and relapse. METHODS: This multicenter retrospective study included 276 pemphigus patients who received initial RTX combined with GCs. Univariate and multivariate logistic regression analyses were performed to identify predictors of CR mini and relapse. RESULTS: Over 52 weeks, 134 (48.6%) patients achieved CR mini, and 35 (12.7%) relapsed. Independent predictors for CR mini were three RTX infusions, higher baseline IgM level and absence of baseline herpes simplex virus infection. For relapse, independent predictors were higher body weight, prior immunosuppressant use, and prior cyclophosphamide use. Adverse events occurred in 23.2% of patients, primarily infections, with no significant differences across prognostic subgroups. LIMITATIONS: Retrospective design and absence of dynamic biomarkers. CONCLUSION: This study identifies readily obtainable baseline predictors for CR mini and relapse in RTX-treated pemphigus, facilitating early risk stratification and individualized treatment strategies to optimize long-term outcomes.