title: Treating pemphigus vulgaris with prednisone and mycophenolate mofetil: a multicenter, randomized, placebo-controlled trial.
abstract: Non-blinded trials of pemphigus vulgaris suggest that mycophenolate mofetil (MMF) may be beneficial. In a prospective, multicenter trial, outpatients with mild or moderate pemphigus vulgaris were randomized to MMF (2 or 3 g day(-1)) plus oral corticosteroids or placebo plus oral corticosteroids for 52 weeks. The primary end point was the proportion of patients in the placebo and combined MMF groups responding to treatment (absence of new, persistent oral or cutaneous lesions, and prednisone dose < or = 10 mg day(-1) from weeks 48 to 52). Of 96 randomized patients, 94 were given treatment and 75 completed the study. Treatment responses occurred in 40 of 58 patients (69.0%) in the combined MMF group and 23 of 36 (63.9%) in the placebo group (P=0.6558, 95% confidence interval -17.4 to 27.6). MMF-treated patients showed faster and more durable responses. In post hoc analyses, more patients taking MMF showed sustained responses for 3 or 6 months than did placebo patients. MMF was well tolerated. Although MMF did not show an advantage on the primary end point, there seemed to be a beneficial treatment effect on several secondary end points, including time to response and duration of response. Thus, MMF may be a potentially useful agent in patients with mild or moderate pemphigus vulgaris.
authors.affiliation: Department of Dermatology, University of Münster, Münster, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Beissert
authors.forename: Daniel
authors.initials: D
authors.lastname: Mimouni
authors.forename: Amrinder J
authors.initials: AJ
authors.lastname: Kanwar
authors.forename: Neil
authors.initials: N
authors.lastname: Solomons
authors.forename: Veena
authors.initials: V
authors.lastname: Kalia
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Anhalt
mesh_terms: D000284:Administration, Oral; D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010045:Outpatients; D010392:Pemphigus / Q000188:drug therapy* / Q000473:pathology; D010919:Placebos; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D010919:Placebos; D009173:Mycophenolic Acid; D011241:Prednisone