title: A Comparative Effectiveness Research of Azathioprine and Cyclophosphamide on the Clinical and Serological Response in Pemphigus Vulgaris.
abstract: BACKGROUND
  A prospective study was carried out to examine the efficacy of cyclophosphamide and azathioprine in pemphigus vulgaris.
  
  
  OBJECTIVE
  To compare the clinical and serological effect of azathioprine and cyclophosphamide in pemphigus patients.
  
  
  METHODS
  Prospective, institutional based study was conducted twenty-one patients of pemphigus vulgaris were initiated on either azathioprine (n = 9) or cyclophosphamide (n = 7) in addition to prednisolone and were evaluated clinically (mucosal and cutaneous severity) and serologically enzyme-linked immunosorbent assay (ELISA) at 0, 3 and 6 months.
  
  
  RESULTS
  Azathioprine had a slower onset of action with a statistically significant improvement seen by 6 months (P = 0.016). Cyclophosphamide had a faster onset of action (3 months) though there was no statistical difference in the efficacy between the two at the end of 6 months. The (RonT) was 33.3-44.4% for azathioprine and 28.8-42.9% for cyclophosphamide at 6 months. Though ELISA had a high sensitivity and specificity for diagnosis, as a tool for assessing therapeutic response a significant decrease was seen only till 3 months. This was restricted to Dsg1 for the azathioprine group and both Dsg3 and Dsg1 levels for the cyclophosphamide group. There were two deaths, both in the cyclophosphamide group.
  
  
  CONCLUSIONS
  Azathiorpine and cyclophosphamide are equally effective for mucosal and cutaneous disease in pemphigus after 6 months of therapy. Dsg ELISA is useful for diagnosis of pemphigus but is not a useful tool for monitoring response to therapy.
authors: Department of Dermatology, Maulana Azad Medical College, New Delhi, India.
authors: Kabir
authors: K
authors: Sardana
authors: Department of Dermatology, Maulana Azad Medical College, New Delhi, India.
authors: Pooja
authors: P
authors: Agarwal
authors: Department of Dermatology, Maulana Azad Medical College, New Delhi, India.
authors: Shivani
authors: S
authors: Bansal
authors: Department of Dermatology, Maulana Azad Medical College, New Delhi, India.
authors: Beena
authors: B
authors: Uppal
authors: Department of Dermatology, Maulana Azad Medical College, New Delhi, India.
authors: Vijay K
authors: VK
authors: Garg
keywords: Enzyme-linked immunosorbent assay; immunosuppressants; pemphigus