Pulsed intravenous cyclophosphamide and methylprednisolone therapy in refractory pemphigus

Saha, Mrinal; Powell, Ann‐Marie; Bhogal, B.S.; Mm, Black; Rw, Groves

doi:10.1111/j.1365-2133.2009.09590.x

Cited by 29 publications

(18 citation statements)

References 29 publications

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“…methylprednisolone 1 g daily over 3 consecutive days with 500 mg of cyclophosphamide has also been used for refractory pemphigus. 14 Early studies describe the administration of cyclophosphamide pulses post-plasmapheresis for severe pemphigus vulgaris (PV) and systemic lupus erythematosus (SLE). [15][16][17] Plasmapheresis acutely reduces pathogenic auto-antibodies through a filtration process administered in cycles; however, it is followed by a rebound burst of antibody production within 2 weeks due to a negative feedback mechanism.…”

Section: Dosage and Administration In Dermatologymentioning

confidence: 99%

Cyclophosphamide in dermatology

Kim

Chan

2016

Aust J Dermatology

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Cyclophosphamide is a chemotherapeutic agent which was first discovered in experimental tumours in rats, and it has since been widely used to treat malignancies and severe manifestations of various auto-immune diseases. High-dose chemotherapy and continuous daily oral regimens are associated with significant toxicity profiles, but i.v. pulsed regimens have lowered the rates of adverse effects in rheumatological studies. Cyclophosphamide has been shown to be useful in the treatment of severe autoimmune conditions due to its powerful immunosuppressive ability; however, it remains a relatively underused modality in dermatology. This article reviews the current literature on cyclophosphamide and its clinical applications in dermatology.

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Section: Dosage and Administration In Dermatologymentioning

confidence: 99%

Cyclophosphamide in dermatology

Kim

Chan

2016

Aust J Dermatology

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“…Steroid pulse therapy is widely used to initiate treatment in patients with rapidly progressive and immunologically mediated disorders such as acute graft rejection, Graves ophthalmopathy, pemphigus, and severe systemic lupus erythematosus [24][25][26][27]. Moreover, high doses of systemic steroid can be given with comparative safety within a period of 1 week [28].…”

Section: Introductionmentioning

confidence: 99%

Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis

et al. 2010

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“…Several case studies have shown rituximab to be efficacious (Hertl et al 2008;Arin et al 2005). Cyclophosphamide is also used in refractory cases, but it has an unsafe side effect profile (Saha et al 2009). It can cause hemorrhagic cystitis.…”

Section: Managementmentioning

confidence: 99%

A brief review of pemphigus vulgaris

Sanders

2017

biomed dermatol

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Pemphigus vulgaris is an autoimmune disorder which presents with painful mucocutaneous blisters and erosions. On the skin, they are flaccid bullae or erosions, and on the mucosa, they present as erosions. This disease is rare but is devastating to those who have it; it also is related-perhaps genetically-to other autoimmune conditions. This is to say that a patient can develop pemphigus vulgaris if they have thyroiditis or diabetes mellitus. Biopsy is needed to obtain histopathological evidence of the breakdown of intercellular connections due to the autoimmune attack on components of desmosomes, which are responsible for intercellular integrity above the basement membrane. When these desmosomes are attacked, loss of connection ensues, and the cells break apart at these connections; this leads to fluid buildup, seen grossly as bullae. Treatment of the disease is difficult and sometimes unsafe. For decades, the mainstay of treatment has been glucocorticoids followed by other drugs. Unfortunately, these drugs are systemically absorbed, and the side effect profile can be unfavorable. In the past several years however, more innovative treatments have emerged that may help ease the cost and safety burden to patients. This review highlights the major points about pemphigus vulgaris, its pathophysiology, and its treatment.

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Pulsed intravenous cyclophosphamide and methylprednisolone therapy in refractory pemphigus

Abstract: PPC can be an effective treatment for refractory pemphigus but its adverse effects should be considered prior to therapy and closely monitored in patients on treatment.

Cited by 29 publications

References 29 publications

Cyclophosphamide in dermatology

Cyclophosphamide in dermatology

Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis

A brief review of pemphigus vulgaris

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