Proteinase inhibitors and pemphigus vulgaris. An in vitro and in vivo study.
The aim of this study was to determine the inhibitory effect of clinically usable proteinase inhibitors p-aminomethylbenzoic acid (PAMBA), and aprotinin on acantholysis in skin organ culture and in clinical trials with pemphigus patients. PAMBA added to the culture medium at a concentration of 1 mg/ml fully prevented the acantholysis, while Contrykal at 10 ATrE/ml reduced acantholysis. Subsequently, we treated 12 patients (groups 1) with PAMBA 100-200 mg daily for 7 to 26 days in combination with a moderate dose of corticosteroid (mean dose 36.1 mg prednisolone equivalent) or immunosuppressive drugs. A second group of 12 patients (group 2) were treated with a high dose of corticosteroid (mean 94.2 mg prednisolone equivalent) and immunosuppressive drugs. Evaluation was performed before treatment, after 3 weeks and on discharge using a clinical scoring system. The inclusion of PAMBA in the treatment protocol of group 1 resulted in active disease being brought under control with lower corticosteroid doses. As a result, fewer side effects were observed in group 1 than in group 2. In our opinion, protease inhibitors may be useful as adjuvant drugs in the combination therapy of pemphigus.
Dobrev
H
H
Department of Dermatology, Medical University, Plovdiv, Bulgaria.
Popova
L
L
Vlashev
D
D
D010129:4-Aminobenzoic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000051:Acantholysis / Q000188:drug therapy; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009924:Organ Culture Techniques; D010392:Pemphigus / Q000188:drug therapy* / Q000473:pathology; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012867:Skin / Q000187:drug effects; D062366:para-Aminobenzoates
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D011480:Protease Inhibitors; D062366:para-Aminobenzoates; C015668:4-aminomethylbenzoic acid; D007611:Aprotinin; D010129:4-Aminobenzoic Acid