Oral Gold Therapy (Auranofin) in Pemphigus vulgaris

Abstract

Auranofin (AF), an oral gold salt, was given for 9–18 months to 3 patients with pemphigus vulgaris. There was a slight improvement with significant oral pain relief in 2, and a complete remission in 1. Two patients including the one with the remission, subsequently flared up under AF therapy. Although AF is said to be better tolerated than parenteral gold this limited series suggests that it does not seem to have a superior therapeutic effect in PV.

Management of autoimmune bullous diseases: Pharmacology and therapeutics

“…Oral gold is not more effective than parenteral gold, according to one report of 3 patients. 46 In 1984 Poulin et al reported a series of 13 patients with PV who received combination therapy consisting of prednisone (varying doses) and gold (50 mg/wk). 47 Seven of the patients had complete remission that required no further treatment.…”

Pemphigus Vulgaris

“…Gold decreases autoantibody titers in patients with pemphigus without directly suppressing antibody synthesis or impairing binding of autoantibodies to epidermal antigens. Oral gold does not seem to be more effective than parenteral preparations Salomon and Saurat (1986). The oral form, auranofin, is easier to use and less toxic.…”

Management of Acquired Bullous Skin Diseases

“…40 Although gold sodium thiomalate given intramuscularly may be beneficial in patients with pemphigus, oral therapy (with auranofin) is usually not. 41 Although gold was once commonly used as a second-line agent in pemphigus, it is now given rarely, a development that reflects its efficacy in only a subgroup of patients and the potential risk of side effects during its prolonged administration.…”