Intravenous dexamethasone‐cyclophosphamide pulse therapy in comparison with oral methylprednisolone‐azathioprine therapy in patients with pemphigus: Results of a multicenter prospectively randomized study

Rose, Ellen Cronan; Wever, Sabine; Zillikens, Detlef; Linse, R; Haustein, U.‐F.; Bröcker, Eva‐Bettina

doi:10.1111/j.1610-0378.2005.04747.x

Cited by 53 publications

(8 citation statements)

References 25 publications

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“…28,30,31 The combination of corticosteroids and azatioprine also showed a greater benefit compared to dexamethasone-cyclophosphamide pulse therapy in the treatment of pemphigus, thus reducing the need for additional therapies. 32,33 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of cases of pemphigus vulgaris and pemphigus foliaceus from a reference service in Pará state, Brazil

Pires

Viana

Araújo

et al. 2014

An. Bras. Dermatol.

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BACKGROUND Pemphigusis a bullous, rare and chronic autoimmune disease. There are two major forms of pemphigus: vulgaris and foliaceus. Epidemiological data and clinical outcome in patients diagnosed in the Brazilian Amazon states are still rare. OBJECTIVES To study the occurrence of the disease during the study period and analyze the epidemiological profile of patients, the most common subtype of pemphigus, and the clinical evolution of patients. METHODS Retrospective analysis of medical records of hospitalized patients with pemphigus foliaceus and pemphigus vulgaris in the period from 2003 to 2010 in Dermatology Service of Hospital Fundação Santa Casa de Misericórdia do Pará, Belém, Northern Brazil. RESULTS We found a total of 20 cases of pemphigus during the study period, 8 of which were of foliaceus pemphigus and 12 of vulgaris pemphigus. Pemphigus foliaceus had the predominance of male patients (75%), showed satisfactory clinical evolution, and was characterized by absence of pediatric cases. Pemphigus vulgaris affected more women (66.7%), showed mean hospital stay of 1 to 3 months (50%), and there were three cases of death (25%). The prescribed immunosuppressive drugs included prednisone with or without combination of azathioprine and/or dapsone. Sepsis was associated with 100% of the deaths. CONCLUSIONS The occurrence of the disease is rare, there are no familiar/endemic outbreaks in the sample. Evolution is usually favorable, but secondary infection is associated with worse prognosis. The choice of best drugs to treat pemphigus remains controversial.

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Section: Discussionmentioning

confidence: 99%

Evaluation of cases of pemphigus vulgaris and pemphigus foliaceus from a reference service in Pará state, Brazil

Pires

Viana

Araújo

et al. 2014

An. Bras. Dermatol.

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“…Pemphigus patients require steroids with concomitant adjuvant therapy[ 1 2 3 4 ] and while comparisons between ISA have been performed [ Table 4 ],[ 5 6 7 8 9 ] our focus was to compare azathioprine and cyclophosphamide. To achieve this goal the ISA were initiated at the outset with prednisolone.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 ] Though there is evidence to show that azathioprine may be an effective and safe drug, other drugs have been used, such as mycophenolate mofetil and cyclophosphamide. [ 5 6 7 8 9 10 11 12 ] Very few comparative trials have been done between these drugs[ 5 6 7 8 9 ] and thus the clinicians choice is based more on personal choices than concrete evidence.…”

Section: Introductionmentioning

confidence: 99%

A comparative effectiveness research of azathioprine and cyclophosphamide on the clinical and serological response in pemphigus vulgaris

et al. 2016

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Context:A prospective study was carried out to examine the efficacy of cyclophosphamide and azathioprine in pemphigus vulgaris.Aims:To compare the clinical and serological effect of azathioprine and cyclophosphamide in pemphigus patients.Materials and Methods:Prospective, institutional based study was conducted twenty-one patients of pemphigus vulgaris were initiated on either azathioprine (n = 9) or cyclophosphamide (n = 7) in addition to prednisolone and were evaluated clinically (mucosal and cutaneous severity) and serologically enzyme-linked immunosorbent assay (ELISA) at 0, 3 and 6 months.Results:Azathioprine had a slower onset of action with a statistically significant improvement seen by 6 months (P = 0.016). Cyclophosphamide had a faster onset of action (3 months) though there was no statistical difference in the efficacy between the two at the end of 6 months. The (RonT) was 33.3–44.4% for azathioprine and 28.8–42.9% for cyclophosphamide at 6 months. Though ELISA had a high sensitivity and specificity for diagnosis, as a tool for assessing therapeutic response a significant decrease was seen only till 3 months. This was restricted to Dsg1 for the azathioprine group and both Dsg3 and Dsg1 levels for the cyclophosphamide group. There were two deaths, both in the cyclophosphamide group.Conclusions:Azathiorpine and cyclophosphamide are equally effective for mucosal and cutaneous disease in pemphigus after 6 months of therapy. Dsg ELISA is useful for diagnosis of pemphigus but is not a useful tool for monitoring response to therapy.

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“…DEX, in contrast, is an anti-inflammatory drug of the synthetic glucocorticoid class and is used extensively in clinical practice in managing inflammatory and autoimmune conditions [59], [60]. Although the exact mechanism of action is unknown, DEX acts on a variety of immune cell types, including macrophages, neutrophils and epithelial cells, and suppresses the production of pro-inflammatory cytokines [32], [33].…”

Section: Discussionmentioning

confidence: 99%

Lipopolysaccharide Renders Transgenic Mice Expressing Human Serum Amyloid P Component Sensitive to Shiga Toxin 2

et al. 2011

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Transgenic C57BL/6 mice expressing human serum amyloid P component (HuSAP) are resistant to Shiga toxin 2 (Stx2) at dosages that are lethal in HuSAP-negative wild-type mice. However, it is well established that Stx2 initiates extra-intestinal complications such as the haemolytic-uremic syndrome despite the presence of HuSAP in human sera. We now demonstrate that co-administering purified Escherichia coli O55 lipopolysaccharide (LPS), at a dosage of 300 ng/g body weight, to HuSAP-transgenic mice increases their susceptibility to the lethal effects of Stx2. The enhanced susceptibility to Stx2 correlated with an increased expression of genes encoding the pro-inflammatory cytokine TNFα and chemokines of the CXC and CC families in the kidneys of LPS-treated mice, 48 hours after the Stx2/LPS challenge. Co-administering the glucocorticoid dexamethasone, but not the LPS neutralizing cationic peptide LL-37, protected LPS-sensitized HuSAP-transgenic mice from lethal doses of Stx2. Dexamethasone protection was specifically associated with decreased expression of the same inflammatory mediators (CXC and CC-type chemokines and TNFα) linked to enhanced susceptibility caused by LPS. The studies reveal further details about the complex cascade of host-related events that are initiated by Stx2 as well as establish a new animal model system in which to investigate strategies for diminishing serious Stx2-mediated complications in humans infected with enterohemorrhagic E. coli strains.

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Intravenous dexamethasone‐cyclophosphamide pulse therapy in comparison with oral methylprednisolone‐azathioprine therapy in patients with pemphigus: Results of a multicenter prospectively randomized study

Cited by 53 publications

References 25 publications

Evaluation of cases of pemphigus vulgaris and pemphigus foliaceus from a reference service in Pará state, Brazil

Evaluation of cases of pemphigus vulgaris and pemphigus foliaceus from a reference service in Pará state, Brazil

A comparative effectiveness research of azathioprine and cyclophosphamide on the clinical and serological response in pemphigus vulgaris

Lipopolysaccharide Renders Transgenic Mice Expressing Human Serum Amyloid P Component Sensitive to Shiga Toxin 2

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