Methotrexate in the treatment of pemphigus vulgaris: experience in 23 patients

Tran, Kathleen; Wolverton, Jay E.; Soter, Nicholas A.

doi:10.1111/bjd.12474

Cited by 43 publications

(37 citation statements)

References 17 publications

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“…Although G6PD is X-linked, women who are heterozygous for G6PD mutations can demonstrate wide phenotypic variability owing to random X-inactivation in erythrocytes 228 . Methotrexate (a chemotherapeutic drug) is another steroid-sparing agent, although only small case series support its efficacy in pemphigus 229 . Small case series support the efficacy of cyclosporine (a T cell inhibitor) in pemphigus 230,231 , although larger clinical trials have suggested inferior to no benefit and a higher number of adverse effects in the treatment group 232,233 .…”

Section: Managementmentioning

confidence: 99%

Pemphigus

Kasperkiewicz

Ellebrecht

Takahashi

et al. 2017

Nat Rev Dis Primers

422

429

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Pemphigus is a group of IgG-mediated autoimmune diseases of stratified squamous epithelia, such as the skin and oral mucosa, in which acantholysis (the loss of cell adhesion) causes blisters and erosions. Pemphigus has three major subtypes: pemphigus vulgaris, pemphigus foliaceus and paraneoplastic pemphigus. IgG autoantibodies are characteristically raised against desmoglein 1 and desmoglein 3, which are cell–cell adhesion molecules found in desmosomes. The sites of blister formation can be physiologically explained by the anti-desmoglein autoantibody profile and tissue-specific expression pattern of desmoglein isoforms. The pathophysiological roles of T cells and B cells have been characterized in mouse models of pemphigus and patients, revealing insights into the mechanisms of autoimmunity. Diagnosis is based on clinical manifestations and confirmed with histological and immunochemical testing. The current first-line treatment is systemic corticosteroids and adjuvant therapies, including immunosuppressive agents, intravenous immunoglobulin and plasmapheresis. Rituximab, a monoclonal antibody against CD20+ B cells, is a promising therapeutic option that may soon become first-line therapy. Pemphigus is one of the best-characterized human autoimmune diseases and provides an ideal paradigm for both basic and clinical research, especially towards the development of antigen-specific immune suppression treatments for autoimmune diseases.

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Section: Managementmentioning

confidence: 99%

Pemphigus

Kasperkiewicz

Ellebrecht

Takahashi

et al. 2017

Nat Rev Dis Primers

422

429

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“…A retrospective review by Tran et al . on the adjunctive use of methotrexate in patients with PV has demonstrated its effectiveness as a corticosteroid‐sparing agent; 23 patients with PV were treated with methotrexate, of whom 21 (91%) experienced improvement (as measured by reduction in the prednisolone dose).…”

Section: Adjuvant Drugsmentioning

confidence: 99%

British Association of Dermatologists’ guidelines for the management of pemphigus vulgaris 2017

et al. 2017

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“…Für die Immunsuppressiva Azathioprin, Mycophenolat-Mofetil, Mycophenolsäure, Methotrexat und Cyclophosphamid konnten klinische Studien einen steroideinsparenden Effekt in der adjuvanten Gabe mit systemischen Kortikosteroiden beim Pemphigus vulgaris/foliaceus aufweisen [3][4][5][6][7][8][9][10][11].…”

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