Pulse therapy for pemphigus: The burden of proof

Singh, Sanjay; Chaudhary, Rahul

doi:10.4103/0378-6323.45235

Cited by 9 publications

(10 citation statements)

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“…However, there are patients, in whom the disease becomes exacerbated as the dose of prednisone is tapered or do not respond to GC treatment, suggesting GC resistance. The advances in the understanding of the pathogenesis of the disease and the development of new therapies decreased the mortality rate from 60% to 90% to about 10% [22,35,36]. B cell-directed therapy using anti-CD20 antibody rituximab directly interferes with pathogenic autoantibodies and induces rapid clinical remission and long-term control in M; + Control vs. Pemphigus difficult to treat pemphigus.…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoid Sensitivity and Proinflammatory Cytokines Pattern in Pemphigus

2012

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Glucocorticoids (GC) represent the main treatment for pemphigus; however, some patients show GC resistance. GC sensitivity was evaluated in 19 pemphigus patients and 41 controls by the number of binding sites [B max (fmol/mg protein)] and the affinity of GC receptor [Kd (nM)] to dexamethasone (DEX) as well as by the pattern of cytokine by DEXmediated inhibition of concanavalin-A (Con-A)-stimulated PBMC proliferation. The Kd (15.7±2.8 vs.8.1±1.3) and Bmax (6.5±0.9 vs. 3.9±0.3) were higher in pemphigus than controls (p00.002). Considering the values above the 95th percentile of normal group as a cut-off (K d >24.9 nM and B max >8.1 fmol/mg protein), elevated K d and B max were observed in 9.8% and 2.4% of controls and 15.8% and 36.8% of patients (p00.02). PBMC proliferation was stimulated by Con-A and inhibited by DEX (p<0.001) in both pemphigus and control groups. IL-6 and TNFα (pg/mL) basal production were higher in patients than controls. There was an increment of these cytokines after Con-A stimulation, and they were inhibited by DEX (p00.002) in controls and remained elevated in pemphigus (p<0.02). Patients and controls showed no difference in basal and stimulated production of IL-8 and IL-10. There is an alteration on GC sensitivity in pemphigus patients and a higher production of proinflammatory cytokines. Therefore, in pemphigus patients, proinflammatory cytokines might be involved in the mechanism of GC resistance and/or in its maintenance.

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Section: Discussionmentioning

confidence: 99%

Glucocorticoid Sensitivity and Proinflammatory Cytokines Pattern in Pemphigus

2012

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“…[2] I find it strange that authors of the letter and some others like them use a different method for treating pemphigus which fails and they conclude that the DCP regimen used by us is 'faith-healing' and unacceptable. Is there anything that prevents my colleagues to visit my clinic and see the patients who are recovering/ have recovered with the DCP regimen.…”

Section: Authors' Replymentioning

confidence: 87%

“…Sir, I wish to refer to the paper of Pasricha and Poonam who claim that dexamathasone-cyclophosphamide pulse therapy can cure pemphigus, [1] the comment of Singh and Chaudhary who found this conclusion unacceptable since evidence was very poor due to lack of randomized controlled trials (RCT) addressing this issue, [2] the reaction of Kanwar and De who support the claim, [3] and the response of Singh, who had to defend on misquoting and personal critisism, explaining that faith is insufficient to accept such a claim. [4] The basis of the discussion is that Pasricha and his followers do not feel the need to perform an RCT on pulse therapy on pemphigus since it works in their experience and in different centers in India.…”

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confidence: 98%

“…However, we provided a steroid sparing agent, azathioprine, in high dose for the complete period of the trial, to give the pulse therapy a level playing field for comparison to placebo that was found a prerequisite condition by Singh and Chaudhary. [2] Moreover, in a randomized controlled open-label trial in pemphigus vulgaris by Chams-Davatchi et al, [7] azathioprine appeared as more effective to reduce steroid dosage than cyclophosphamide.…”

mentioning

confidence: 98%

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Dexamethasone pulse therapy: Evidence for no benefit in pemphigus

Jonkman¹

2011

Indian J Dermatol Venereol Leprol

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“…We read with great interest the letter by Singh and Chaudhary [1] in response to the article by Pasricha and Poonam entitled 'Current regimen of pulse therapy for pemphigus: Minor modifications, improved results'. [2] They meticulously discussed the drawbacks of the study in question and at the end almost dismissed pulse therapy as a treatment option for pemphigus.…”

Section: Sirmentioning

confidence: 99%