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Controlled Study of Plasma Exchange in Pemphigus
Jean-Claude Guillaume, MD;
Jean-Claude Roujeau, MD;
Patrice Morel, MD;
Marie-Sylvie Doutre, MD;
Bernard Guillot, MD;
Daniel Lambert, MD;
Phillipe Lauret, MD;
Gérard Lorette, MD;
François Prigent, MD;
Raoul Triller, MD;
Loïc Vaillant, MD
Arch Dermatol. 1988;124(11):1659-1663.
Abstract
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• To determine the potential steroid sparing effect of plasma exchange in pemphigus we enrolled 40 patients in a multicenter randomized study. Eighteen patients were treated by prednisolone alone, 22 by prednisolone plus ten large-volume plasma exchanges over four weeks. All patients received oral prednisolone in the same initial dosage (0.5 mg/kg/d), which was increased weekly if needed. The number of cases controlled at each therapeutic step did not differ between the two groups. In eight cases, four in each group, the disease was not controlled by the highest therapeutic step of the protocol, with four deaths from sepsis in the plasma exchange group. The controlled cases needed similar cumulative prednisolone doses (5237 ± 5512 mg in the plasma exchange group vs 4246 ± 1601 mg in the control group). The evolution of serum pemphigus antibody was not different in the two groups. These findings suggest that plasma exchange in association with low steroid doses alone are not effective in the treatment of pemphigus and may even promote sepsis.
(Arch Dermatol 1988;124:1659-1663)
Author Affiliations
From the Departments of Dermatology, Hôpital Henri Mondor, Université Paris XII (Drs Guillaume and Roujeau); Hôpital St Louis, Université Paris VII (Drs Morel and Prigent); Hôpital du Haut-Lévêque, Université de Bordeaux (Dr Doutre); Hôpital St Charles, Université de Montpellier (Dr Guillot); Hôpital du Bocage, Université de Dijon (Dr Lambert); Hôpital Charles Nicolle, Université de Rouen (Dr Lauret); Hôpital Trousseau, Université de Tours (Drs Lorette and Vaillant); and Hôpital de Sebastopol, Université de Reins (Dr Triller) (France).
Footnotes
Accepted for publication April 8, 1988.
Presented in part at the First International Meeting on Hemapheresis, Dijon, France, November 1984.
Reprint requests to Service de Dermatologie, Hôpital Henri Mondor, 94010 Créteil, France (Dr Guillaume).
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