Immunosuppressants and prednisone in pemphigus vulgaris: therapeutic results obtained in 63 patients between 1961 and 1975

Abstract

Evaluation of the treatment in 63 patients with pemphigus vulgaris showed that six patients (9.5%) died of the consequences of high-dosage prednisone treatment, while 24 patients (38.1%) were free of lesions and not receiving treatment. Immunosuppressants (methotrexate, cyclophosphamide, and azathioprine) are of value in patients with severe pemphigus vulgaris since they often reduce the maintenance dose of prednisone required after high-dosage prednisone treatment. Immunosuppressants are of even greater value in patients in the early, stable stage of pemphigus vulgaris. Of 16 such patients initially treated with a combination of an immunosuppressant and maintenance doses of prednisone not exceeding 40 mg on alternate days, 13 at no time required treatment with higher doses of prednisone. The good results obtained with this method emphasize the importance of diagnosing and treating pemphigus vulgaris in its early stage.

Azathioprine in the Treatment of Autoimmune Blistering Diseases

“…At the same time, Aberer and colleagues 16 published a case series of 4 patients describing the use of azathioprine as "steroid saving and beneficial" in patients with pemphigus. In 1977, Lever and SchaumburgLever 17 published a retrospective analysis of 63 patients with pemphigus. The investigators treated patients (n 5 12) with prednisone monotherapy and the other patients in this cohort (n 5 51) with a combination of azathioprine, cyclophosphamide, or methotrexate and prednisone.…”

A Comparison of Oral Methylprednisolone Plus Azathioprine or Mycophenolate Mofetil for the Treatment of Pemphigus

“…In the past few years, several strategies for the use of corticosteroids to treat pemphigus have been advocated. The original recommendation by Lever and Schaumburg-Lever 18 was to give patients a fixed daily dose of prednisolone (200-400 mg) over up to 8 weeks.…”

Immunohistochemistry versus immunofluoresence in the diagnosis of autoimmune blistering diseases

“…In classic ABD immunofluoresence testing, a single fluorophore (fluorescein isothiocyanate; FITC) has been utilized, and it has been accepted that background autofluorescence exists [5]. Further, it is assumed that diagnostic DIF/IIF reactivity in ABD patients will vary depending on concomitant administration of therapeutic immunosupressor agents [6]. In addition, correlation of serum antibodies with disease severity in pemphigus and bullous pemphigoid (BP) via IIF is widely utilized [8,9].…”