The use of sulfasalazine and pentoxifylline (low-cost antitumour necrosis factor drugs) as adjuvant therapy for the treatment of pemphigus vulgaris: a comparative study.
BACKGROUND
Pemphigus vulgaris (PV) represents a potentially life-threatening autoimmune blistering disease in which IgG autoantibodies are directed against cell-cell adhesion molecules. Tumour necrosis factor (TNF)-alpha has been suggested to have a possible role in the mechanism underlying acantholysis.


OBJECTIVE
This comparative double-blinded study was carried out to estimate the use of both sulfasalazine (SSZ) and pentoxifylline (PTX) (low-cost anti-TNF drugs) as an adjuvant therapy for PV.


METHODS
The study included 64 patients with PV: 42 patients received the full treatment regimen (with SSZ and PTX) and 22 patients followed the same regimen except they received placebo instead of PTX and SSZ. Five healthy subjects were included as controls. Serum samples were taken to measure TNF-alpha levels in the control group and before starting treatment in both the patient groups and this was repeated every 2 weeks for 8 weeks; a clinical assessment was made every week for all the patients.


RESULTS
The serum level of TNF-alpha was statistically higher in both groups of patients than in the healthy individuals. There was a statistically significant decrease in the serum levels of TNF-alpha in patients in group 1 compared with those in group 2 at 6 and 8 weeks. There was also a significant clinical improvement in patients in group 1 compared with those in group 2.


CONCLUSIONS
The use of PTX and SSZ as adjuvant therapy in the treatment of PV induced a faster and more significant decrease in the serum level of TNF-alpha, and this decrease was associated with rapid clinical improvement.
el-Darouti
M
M
Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Marzouk
S
S
Abdel Hay
R
R
el-Tawdy
A
A
Fawzy
M
M
Leheta
T
T
Gammaz
H
H
Al Gendy
N
N
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004534:Egypt; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D010431:Pentoxifylline / Q000191:economics / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D013256:Steroids / Q000627:therapeutic use; D012460:Sulfasalazine / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000097:blood*; D055815:Young Adult
D015415:Biomarkers; D010726:Phosphodiesterase Inhibitors; D013256:Steroids; D014409:Tumor Necrosis Factor-alpha; D012460:Sulfasalazine; D003520:Cyclophosphamide; D010431:Pentoxifylline