A randomized comparative study of the effect of betamethasone oral mini-pulse therapy versus oral azathioprine in progressive nonsegmental vitiligo

Patra, Suman; Khaitan, Binod K.; Sharma, Vinod; Khanna, Neena

doi:10.1016/j.jaad.2019.03.025

Cited by 28 publications

(37 citation statements)

References 4 publications

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“…In a 12‐week single‐arm study, oral cyclosporine (3 mg/kg daily) halted disease progression in 61% (11/18) and induced various degrees of repigmentation in 50% (9/18) 45 . Azathioprine (50 mg twice daily) less effectively arrested disease progression in 6 months (77.8% [14/18]) than OMP (5 mg on two consecutive days weekly: 89.5% [17/19]) 46 . However, combination oral azathioprine (0.6‐0.75 mg/kg)/PUVA phototherapy afforded better repigmentation than PUVA phototherapy alone after 4 months (mean repigmentation rates: 58.4% vs. 24.8%) 47 …”

Section: Resultsmentioning

confidence: 99%

Development of evidence‐based consensus on critical issues in the management of patients with vitiligo: A modified Delphi study

Bae

Jeong

Choi

et al. 2020

Photoderm Photoimm Photomed

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Background/purpose: Vitiligo remains a major challenge in dermatology. However, much of the treatment remains unclear, because little evidence is available. We sought to answer some critical questions pertaining to management of vitiligo patients. Methods: A modified Delphi process among 31 vitiligo experts was conducted. A total of 12 clinical vitiligo treatment questions without clear answers were collected How to cite this article: Bae JM, Jeong K-H, Choi CW, et al.

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Section: Resultsmentioning

confidence: 99%

Development of evidence‐based consensus on critical issues in the management of patients with vitiligo: A modified Delphi study

Bae

Jeong

Choi

et al. 2020

Photoderm Photoimm Photomed

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“…when OMP therapy was administered as monotherapy. 17,19 None of the patients in Patra et al's study achieved a repigmentation rate of more than 25% after undergoing OMP therapy as a monotherapy. 19…”

Section: Repigmentationmentioning

confidence: 95%

“…The oldest study included was conducted in 2008, 22 while the most recent was conducted in 2019 19 ; only one of the studies had clinical registry information. 19 All RCTs were from India and covered a wide range of interventions; two of these studies used betamethasone as OMP therapy, 19,22 while another two used dexamethasone. 20,21 The treatment was administered once a day, two times per week on consecutive days.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Oral mini‐pulse therapy in vitiligo: a systematic review

et al. 2021

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Background There is limited evidence supporting the use of alternative treatments for patients with nonstable vitiligo.Objective This study aimed to review the effects of oral mini-pulse (OMP) therapy in the management of nonsegmental vitiligo. MethodsThe following databases were searched between inception and May 2020 for relevant studies: Scopus, Web of Science, MEDLINE, and Embase. All randomized controlled trials that compared OMP therapy with any other active treatment or placebo for nonstable vitiligo were included. The Cochrane's risk of bias tool was used to evaluate the risk of bias (ROB) in selected studies, and the overall quality of evidence of each outcome was assessed using the Grading Recommendations, Assessment, Development, and Evaluations (GRADE) system.Results Four studies met our selection criteria. All of them were conducted in India and included 246 patients. OMP therapy included betamethasone or dexamethasone. The duration of treatment was 6 months in all studies. Up to 32% of patients achieved a repigmentation rate of >75% when OMP therapy was administered as monotherapy. No difference was observed between OMP therapy and other treatments in arresting the disease, and weight gain was the most frequent adverse effect. The overall ROB in all included studies was relatively high because of the randomization process, outcome measurement and informed selection of outcomes. ConclusionBased on the findings of these studies, OMP therapy did not demonstrate additional value compared with other treatments. Hence, there is an urgent need to conduct high-quality clinical trials to evaluate this therapy.

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“…In the second month of treatment, vitiligo was stabilized in 19 of 23 patients treated with OMP and in four of 22 treated with azathioprine. 39 None of the authors indicated the use of this medication.…”

Section: Systemic Therapiesmentioning

confidence: 96%

Consensus on the treatment of vitiligo – Brazilian Society of Dermatology

Dellatorre¹,

Antelo

Bedrikow

et al. 2020

Anais Brasileiros de Dermatologia

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Background Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.

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A randomized comparative study of the effect of betamethasone oral mini-pulse therapy versus oral azathioprine in progressive nonsegmental vitiligo

Abstract: Fig 2. A patient in the oral mini-pulse group and a patient in the azathioprine group showing repigmentation with good color match after 6 months.

Cited by 28 publications

References 4 publications

Development of evidence‐based consensus on critical issues in the management of patients with vitiligo: A modified Delphi study

Development of evidence‐based consensus on critical issues in the management of patients with vitiligo: A modified Delphi study

Oral mini‐pulse therapy in vitiligo: a systematic review

Consensus on the treatment of vitiligo – Brazilian Society of Dermatology

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