Intermittent high-dose dexamethasone-cyclophosphamide therapy for pemphigus

Abstract

Since 1982, we have treated 79 pemphigus patients with an arbitrarily designed regimen of 100 mg dexamethasone dissolved in 5% glucose given by an intravenous infusion over 1 h, daily on 3 consecutive days and in addition, 500 mg cyclophosphamide on day 1 only. The intermittent high doses (IHD) of dexamethasone are repeated every 2-4 weeks, and the patient continues to take 50 mg/day oral cyclophosphamide. This treatment is divided into four phases. During Phase I, the patient continues to develop relapses of pemphigus a variable number of days after IHD, but the lesions heal up quickly after IHD. These relapses become progressively milder and stop after a few months, but the IHD are continued once a month for 6-9 months (Phase II). In the next phase (Phase III), the monthly IHD are stopped, and the patient continues to take 50 mg/day cyclophosphamide orally. After approximately 1 year this maintenance treatment is withdrawn and the patient is observed for any relapses (Phase IV). Of the 79 patients treated, 10 patients have been lost to follow-up and two have died, one due to leukopaenia caused by inadvertent additional administration of methotrexate, and the other of an unknown cause. Of the remaining 67 patients, 25 are off treatment (Phase IV), 25 are taking only 50 mg cyclophosphamide daily (Phase III), ten are also in remission, but still receiving intermittent high doses of dexamethasone-cyclophosphamide (Phase II), and seven still have active disease (Phase I).(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…Cyclophosphamide is often used as a pulse treatment in combination with prednisolone, especially in eastern Eurasia. [28][29][30]44 By inducing DNA cross-linkage, cyclophosphamide has a different mode of action compared with azathioprine and mycophenolate mofetil. Cyclophosphamide treatment is more effective but is related to a higher inci- ( dence of adverse effects when compared with azathioprine or mycophenolate mofetil.…”

“…12,14,[22][23][24][25][26][27][28][29][30] Azathioprine has been used successfully for nearly 4 decades as an adjuvant in combination with corticosteroids. The active metabolite of azathioprine is mercaptopurine, which is intracellularly converted to 6-thionine acid.…”

Pemphigus Vulgaris: Update on Etiopathogenesis, Oral Manifestations, and Management

“…Chlorambucil (Shah et al, 2000), azathioprine (Roenigk and Deodhar, 1973), or cyclophosphamide Schaumburg-Lever, 1977, 1984;Fellner et al, 1978;Piamphongsant, 1979;Ruocco, 1988;Pasricha et al, 1988Pasricha et al, , 1995 may be effective, the latter sometimes being effective when azathioprine is not (Ahmed and Hombal, 1987). Immunoablative high-dose cyclophosphamide without stem cell rescue has been successful in one patient (Hayag et al, 2000).…”

Pemphigus Vulgaris: An Insight on Conventional and Emerging Treatment Modalities

“…The most common adverse effects in patients taking mycophenolate mofetil are leukopenia, anemia, gastrointestinal distress including nausea and diarrhea, and elevation of transaminases . 40 …”