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Ineffectiveness of Cyclosporine as an Adjuvant to Corticosteroids in the Treatment of Pemphigus
Demetris Ioannides, MD;
Fotis Chrysomallis, MD;
Jean-Claude Bystryn, MD
Arch Dermatol. 2000;136:868-872.
Objective To compare the effectiveness and the adverse effects of 2 different regimens for the treatment of pemphigus: corticosteroids alone compared with a combination of corticosteroids and cyclosporine.
Design Concurrently randomized trial.
Setting Tertiary care medical center.
Patients and Methods We studied 33 sequential hospitalized patients with newly diagnosed pemphigus vulgaris (n=29) or pemphigus foliaceous (n=4) based on clinical, histological, and immunofluorescence criteria who had not previously been treated with systemic corticosteroids or immununosuppressive drugs. Patients were randomly assigned to treatment with methylprednisolone or prednisolone plus cyclosporine.
Intervention Both groups were treated with similar initial doses of prednisolone (prednisone equivalent, 1 mg/kg), which were increased 50% every 5 to 10 days based on persistence of disease activity. One group was treated in addition with cyclosporine (5 mg/kg).
Main Outcome Measures Patients were followed up closely for clinical outcome based on time required to control active manifestations of the disease, induction of partial and complete remissions, total amount of corticosteroids administered, frequency of relapses, and development of complications.
Results The 2 groups were similar in terms of demographics and baseline disease severity. There was no difference between groups in any of the variables used to measure response to treatment or total amount of corticosteroids administered. Complications were more common in patients who received combination therapy.
Conclusion Combination treatment with corticosteroids and cyclosporine, 5 mg/kg, offers no advantage over treatment with corticosteroids alone in patients with pemphigus.
From the Department of Dermatology, Aristotle University School of Medicine, Thessaloniki, Greece (Drs Ioannides and Chrysomallis); and the Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York (Dr Bystryn).
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