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A Comparison of Oral Methylprednisolone Plus Azathioprine or Mycophenolate Mofetil for the Treatment of Pemphigus
Stefan Beissert, MD;
Thomas Werfel, MD;
Uta Frieling, MD;
Markus Böhm, MD;
Michael Sticherling, MD;
Rudolf Stadler, MD;
Detlev Zillikens, MD;
Berthold Rzany, MD;
Nicolas Hunzelmann, MD;
Michael Meurer, MD;
Harald Gollnick, MD;
Thomas Ruzicka, MD;
Hans Pillekamp, MD;
Volker Junghans, MD;
Thomas A. Luger, MD
Arch Dermatol. 2006;142:1447-1454.
Objective To investigate the safety and efficacy of oral methylprednisolone combined with azathioprine sodium or mycophenolate mofetil for the treatment of pemphigus.
Design A prospective, multicenter, randomized, nonblinded clinical trial to compare 2 parallel groups of patients with pemphigus (pemphigus vulgaris and pemphigus foliaceus) treated with oral methylprednisolone plus azathioprine or oral methylprednisolone plus mycophenolate mofetil.
Settings Thirteen departments of dermatology in Germany.
Patients We included patients with pemphigus vulgaris (n = 33) or pemphigus foliaceus (n = 7) evidenced by clinical lesions suggestive of pemphigus, intraepidermal blistering on histological analysis of skin biopsy specimens, intercellular deposition of IgG within the epidermis, and immunoblot analysis findings for antidesmoglein 3 and/or antidesmoglein 1 autoantibodies.
Main Outcome Measures The cumulative total methylprednisolone doses and rate of remission. Secondary outcome measures were safety profiles and duration of remission.
Results In 13 (72%) of 18 patients with pemphigus receiving oral methylprednisolone and azathioprine, complete remission was achieved after a mean ± SD of 74 ± 127 days compared with 20 (95%) of 21 patients receiving oral methylprednisolone and mycophenolate mofetil in whom complete remission occurred after a mean ± SD of 91 ± 113 days. The total median cumulative methylprednisolone dose used was 8916 mg (SD, ±29 844 mg) in the azathioprine group compared with 9334 mg (SD, ±13 280 mg) in the mycophenolate group. In 6 (33%) of 18 patients treated with azathioprine, grade 3 or 4 adverse effects were documented in contrast to 4 (19%) of 21 patients who received mycophenolate mofetil.
Conclusion Mycophenolate mofetil and azathioprine demonstrate similar efficacy, corticosteroid-sparing effects, and safety profiles as adjuvants during treatment of pemphigus vulgaris and pemphigus foliaceus.
Author Affiliations: Departments of Dermatology, University of Münster, Münster (Drs Beissert, Frieling, Böhm, and Luger), Medical School Hannover, Hannover (Dr Werfel), University of Kiel, Kiel (Dr Sticherling), University of Leipzig, Leipzig (Dr Sticherling), Municipal Hospital Minden, Minden (Dr Stadler), University of Würzburg, Würzburg (Dr Zillikens), University of Lübeck, Lübeck (Dr Zillikens), Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim (Dr Rzany), University of Cologne, Cologne (Dr Hunzelmann), University of Dresden, Dresden (Dr Meurer), University of Magdeburg, Magdeburg (Dr Gollnick), University of Düsseldorf, Düsseldorf (Dr Ruzicka), University of Ulm, Ulm (Dr Pillekamp), and University of Göttingen, Göttingen (Dr Junghans), Germany; and Division of Evidenced-Based Medicine, Department of Dermatology, Charité-Universitätsmedizin, Berlin, Germany (Dr Rzany).
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