An alternate-day corticosteroid regimen for pemphigus vulgaris. A 13-year prospective study.
BACKGROUND
Pemphigus vulgaris (PV) at the early, usually oral and relatively stable stage, represents the majority of PV patients. Treatment modalities usually do not differ compared to those for the fully established disease.


OBJECTIVE
To prospectively assess a standardized and effective therapeutic approach that aims at less morbidity due to adverse reactions.


METHODS
The following regimen, also known as Lever's mini treatment (LMT), was used. Forty mg of oral prednisone on alternate days plus 100 mg azathioprine every day were administered until the complete healing of all lesions. A gradual monthly and later bimonthly decrease of prednisone was followed by the tapering of a second immunosuppressive agent, in a one-year period.


RESULTS
Seventy-four patients suffering from early-stage-PV, and representing 70% of all PV patients seen through the years 1991-2003, were eligible in the study. Total follow-up period was 76 +/- 37 (26-180) months. During the 53 +/- 26 months of LMT, 6 (8%) patients dropped out of therapy, 9 (12%) required a change to another treatment, two (3%) died and 57 (77%) achieved a lesion-free condition. Forty-five (61%) patients were in complete remission for 27 +/- 29 months. Significant morbidity was estimated 4/74 (5.2%). Disease 'breakthroughs' necessitating treatment adjustments occurred in 30 patients, usually throughout the last phase of therapy and post-treatment follow-up.


CONCLUSIONS
LMT may be a standardized therapeutic approach for the early and relatively stable stage of PV, resulting in high efficacy, safety and quality of life profile.
Chaidemenos
G Ch
GCh
Hospital for Skin and Venereal Diseases, State Department of Dematology and Venereology, Thessaloniki, Greece. georgechaidemenso@yahoo.co.uk
Mourellou
O
O
Koussidou
T
T
Tsatsou
F
F
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone