The Add-on Effect of an Immunosuppressant for Pemphigus from the Consolidation Phase to the Maintenance Phase

Sugimoto Saeko, Aoyama Yumi, Iwatsuki Keiji

doi:10.14924/dermatol.125.1911

Immunosuppressive therapy is one of the options available for the initial treatment of severe pemphigus in the control phase. In this retrospective study, the add-on effect of an immunosuppressant as an adjuvant therapy to systemic corticosteroid therapy from the consolidation phase to the maintenance phase was examined. The cases of 16 of the 35 pemphigus patients in the consolidation phase or in the maintenance phase treated with an immunosuppressant at Okayama University Hospital between 2012 and 2014 were analyzed. Outcomes were evaluated based on the degree of changes in the Pemphigus Disease Area Index, serum autoantibody levels, and dose of corticosteroid. When at least one of these evaluation points declined, the treatment was judged as effective. Thirteen patients received azathioprine, four received cyclosporine, and eight received mizoribine in combination with systemic corticosteroid therapy during the clinical course. Effective add-on therapy was observed in 92%, 100%, and 63% of the patients treated with azathioprine, cyclosporine and mizoribine, respectively. Progression of disease activity after discontinuation of the immunosuppressant was observed in 46%, 50%, and 25% of these groups. These data indicate that the addition of either azathioprine or cyclosporine to corticosteroid therapy is a viable treatment option in pemphigus patients who are unresponsive to corticosteroids during the consolidation to maintenance phases.

The Add-on Effect of an Immunosuppressant for Pemphigus from the Consolidation Phase to the Maintenance Phase

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