Ineffectiveness of Cyclosporine as an Adjuvant to Corticosteroids in the Treatment of Pemphigus

Abstract

Patients and Methods: We studied 33 sequential hospitalized patients with newly diagnosed pemphigus vulgaris (n=29) or pemphigus foliaceous (n =4) based on clinical, histological, and immunofluorescence criteria who had not previously been treated with systemic corticosteroids or immununosuppressive drugs. Patients were randomly assigned to treatment with methylprednisolone or prednisolone plus cyclosporine. Intervention: Both groups were treated with similar initial doses of prednisolone (prednisone equivalent, 1 mg/ kg), which were increased 50% every 5 to 10 days based on persistence of disease activity. One group was treated in addition with cyclosporine (5 mg/kg). Main Outcome Measures: Patients were followed up closely for clinical outcome based on time required to control active manifestations of the disease, induction of partial and complete remissions, total amount of corticosteroids administered, frequency of relapses, and development of complications. Results: The 2 groups were similar in terms of demographics and baseline disease severity. There was no difference between groups in any of the variables used to measure response to treatment or total amount of corticosteroids administered. Complications were more common in patients who received combination therapy. Conclusion: Combination treatment with corticosteroids and cyclosporine, 5 mg/kg, offers no advantage over treatment with corticosteroids alone in patients with pemphigus.

Gold

“…So konnten Chrysomallis et al [8] beim Vergleich zwischen Prednison (40 mg) als Monotherapie und der Kombination aus 40 mg Prednison und verschiedenen Cyclophosphamiddosierungen keinen signifikanten Unterschied zwischen den jeweiligen Gruppen nachweisen. Auch die Kombination von Prednisolon mit Cyclosporin zeigte gegenüber der Monotherapie mit Prednisolon keinen Vorteil [15].…”

Recalcitrant Pemphigus Vulgaris Responding to Systemic Tacrolimus

“…Cyclosporine seemed to be effective as steroid-sparing agent in small case series of pemphigus patients [12], but a randomized prospective controlled trial did not confirm the beneficial effects in pemphigus [13]. Instead, side effects such as elevation of renal retention parameters and development of hypertension were reported [13]. Therefore, the guideline of the British Association of Dermatologists does not recommend cyclosporine as adjuvant drug in the treatment of PV [11].…”

Treatment of Pemphigus Vulgaris and Pemphigus Foliaceus: A Systematic Review and Meta-Analysis

“…The follow-up period ranged from 1 to 60 months. The characteristics and main efficacy results of the 20 trials are displayed in Table 1 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The majority of studies included patients with newly diagnosed disease [8, 10-12, 14, 16, 18, 21] or a combination of newly diagnosed disease and recurrent disease [9,13,19,20,22,25,27].…”