Methylprednisolone pulse therapy plus adjuvant therapy for pemphigus vulgaris: an analysis of 10 years' experience on 312 patients

Abstract

Steroid pulse therapy has shown satisfactory efficacy and safety in treating pemphigus vulgaris (PV). However, there is a paucity of data about the efficacy and safety of methylprednisolone, despite its frequent administration. The aim of this study is to evaluate the efficacy and safety of steroid pulse therapy in treating PV. In this 10‐year retrospective cohort study, 312 patients with PV, who had received methylprednisolone pulse therapy, were included. Data of pulse therapy sessions, adjuvant medications, dosages, remission rates, complications, and mortalities were collected from all patients. A total of 276 patients out of 312 underwent the final follow‐up at least 6 months after the last session of pulse therapy. Complete remission off therapy was achieved in 83 patients (30%), and 152 patients (55%) had complete remission on therapy. About 29 (10.5%) patients had lesions of pemphigus at the time of the study follow‐up, and 26.8% of remained patients were on the minimal therapy. Methylprednisolone pulse therapy could be considered as an option for proper control of PV in severe cases. It might lead to shorter periods of hospitalization and reduce the need to take long‐term high‐dose oral steroid therapy.

Elevated Serum Levels of Interleukin-15 in Pemphigus Vulgaris Patients: A Potential Therapeutic Target

“…In the case of pemphigus, corticosteroid medications that usually used to suppress auto-antibodies, include delayed and serious side effects [23]. Based on our findings, the elevated levels of IL-15 in sera of patients with pemphigus suggest that this cytokine may actually be involved in pathogenesis of pemphigus.…”

Profil Pemphigus Vulgaris di Instalasi Rawat Inap RSUD Dr. Moewardi Surakarta Periode Januari 2014-Desember 2019

“…(2019) yang menyatakan bahwa pemberian methylprednisolone dosis pulse dengan dosis 20-30 mg/kgBB/hari selama 4 hari berturut-turut memberikan perbaikan klinis pada kasus PV. 41 Penggunaan methylprednisolone dosis pulse masih menjadi perdebatan karena dapat meningkatkan risiko aritmia jantung sehingga tidak disarankan untuk terapi PV. 41 Methylprednisolone dengan pemberian intravena lebih direkomendasikan pada kasus PV untuk menghindari komplikasi akibat terapi corticosteroid oral jangka panjang seperti kejadian osteoporosis serta menghindari komplikasi corticosteroid dosis pulse berupa aritmia jantung.…”

“…41 Penggunaan methylprednisolone dosis pulse masih menjadi perdebatan karena dapat meningkatkan risiko aritmia jantung sehingga tidak disarankan untuk terapi PV. 41 Methylprednisolone dengan pemberian intravena lebih direkomendasikan pada kasus PV untuk menghindari komplikasi akibat terapi corticosteroid oral jangka panjang seperti kejadian osteoporosis serta menghindari komplikasi corticosteroid dosis pulse berupa aritmia jantung. 42 Corticosteroid merupakan antiinflamasi poten dengan efek imunosupresi yang menghambat aktivasi NF-κB, supresi fungsi leukosit dan berbagai cytokines.…”

“…47 Kombinasi dengan immunosuppressant lain sebagai terapi ajuvan dipertimbangkan pada kasus PV yang kurang responsif terhadap pemberian corticosteroid sistemik, untuk meningkatkan efektivitas terapi dan mengurangi efek samping dari pemakaian jangka panjang corticosteroid sistemik seperti DM, hipertensi, osteoporosis, katarak, dan ulkus peptikum. 1,41 Terapi kurang responsif dinilai bukan berdasarkan body surface area (BSA) yang terlibat, namun apabila perbaikan klinis lesi kulit dan mukosa yang dicapai kurang dari 80% atau masih dijumpai bula baru yang muncul selama pasien mendapatkan terapi. 48 Almugairen, dkk.…”

Cutaneous type of pemphigus vulgaris

“…1 The current criterion standard for diagnosing tinea capitis is use of the scrape-culture method to isolate the causative agent. 2 Particularly for young patients, this procedure may be uncomfortable and is rather difficult for physicians to perform. The cotton swab culture technique may be an efficient and effective way to obtain samples from pediatric patients in whom tinea capitis is suspected.…”