title: A comparison of oral methylprednisolone plus azathioprine or mycophenolate mofetil for the treatment of pemphigus.
abstract: OBJECTIVE
  To investigate the safety and efficacy of oral methylprednisolone combined with azathioprine sodium or mycophenolate mofetil for the treatment of pemphigus.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Dermatology, University of Münster, Münster, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Beissert
authors.forename: Thomas
authors.initials: T
authors.lastname: Werfel
authors.forename: Uta
authors.initials: U
authors.lastname: Frieling
authors.forename: Markus
authors.initials: M
authors.lastname: Böhm
authors.forename: Michael
authors.initials: M
authors.lastname: Sticherling
authors.forename: Rudolf
authors.initials: R
authors.lastname: Stadler
authors.forename: Detlev
authors.initials: D
authors.lastname: Zillikens
authors.forename: Berthold
authors.initials: B
authors.lastname: Rzany
authors.forename: Nicolas
authors.initials: N
authors.lastname: Hunzelmann
authors.forename: Michael
authors.initials: M
authors.lastname: Meurer
authors.forename: Harald
authors.initials: H
authors.lastname: Gollnick
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruzicka
authors.forename: Hans
authors.initials: H
authors.lastname: Pillekamp
authors.forename: Volker
authors.initials: V
authors.lastname: Junghans
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Luger
mesh_terms: D000284:Administration, Oral; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001379:Azathioprine / Q000008:administration & dosage*; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D006801:Humans; D007168:IMP Dehydrogenase / Q000037:antagonists & inhibitors; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010392:Pemphigus / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D007168:IMP Dehydrogenase; D009173:Mycophenolic Acid; D001379:Azathioprine; D008775:Methylprednisolone