Minocycline is a useful adjuvant therapy for pemphigus

Abstract

Pemphigus is an autoimmune blistering disease with high mortality if untreated. The cases of 10 patients who had minocycline 100 mg daily added as adjuvant therapy are reported. Prior to the use of minocycline, all patients had active disease, nine were on prednisolone (10-40 mg) and five were on azathioprine (100-200 mg). The response was assessed on clinical improvement and reduction of immunosuppressive (IS) drugs. It was graded into four categories: major, minor, equivocal and no significant response. A major response was seen in four patients, minor in two, equivocal in one and no improvement in three patients. The prednisolone dose in the six responders was reduced to 0-6 mg (0 mg in three patients), with an average decrease of 21 mg. The average time to respond was 8 months. Of the six responders, three were on azathioprine, which was ceased in two patients and reduced by two-thirds in the other patient. No patient ceased minocycline because of side effects. In conclusion, minocycline 100 mg daily is a simple, safe and well tolerated treatment that should be tried in patients with pemphigus to reduce disease activity and/or the dose of potent IS agents.

Pemphigus vulgaris in three adolescents: The course of the disease

“…The suggested initial dose of prednisone is in the range of 2–3 mg/kg/day, with a slow tapering to 0.8 and then to 0.5 mg/kg/day, in approximately 2‐week intervals, when the alternate days schedule may be used for further dose reduction 4 . Other treatment modalities, such as azathioprine, 8,9 cyclophosphamide, 3,8 dapsone, 4,5,10 minocycline, 11 cyclosporine, 8 mycophenolate mofetil, 12 i.v. immunoglobulin, 13 anti‐CD20 monoclonal antibodies, 13 and plasmapheresis, 13 have been used in order to avoid corticosteroid adverse effects.…”

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

“…Two studies using minocycline 50–200 mg per day as an adjuvant drug reported improvement and a corticosteroid‐sparing effect in 54% of patients (seven of 13) …”

Antibiotics used in nonbacterial dermatologic conditions

“…In the patients receiving prednisolone who responded to therapy, the dose was decreased an average of 21 mg with a mean time to response of 8 months. Three of the responders were taking azathioprine, which was able to be discontinued in two and reduced by 2/3 in one (73).…”