RESUMO
Pemphigus vulgaris is a life threatening relapsing disease, the first line in its treatment is systemic steroids, and due to the high rate of side effects caused by systemic steroids in Pemphigus vulgaris patients ,some immunosuppressant drugs have been introduced as an adjuvant steroid sparing agents, and one of these immunosuppressants is azathioprine, which is the most used drug by therapists, but this use was due to experience and not due to strict studies, this research studies the relationship between azathioprine and relapse in pemphigus vulgaris patients during the prednisolone reduction period. 70 Pemphigus vulgaris patients have been studied, from the patients of the dermatology university hospital during the period between 1/8/2008 -29/5/2011 [the first year for collecting the sample and the rest for follow-up] they have been divided into 2 groups. The first: were treated with prednisolone plus azathioprine [30 patients], the second: were treated with prednisolone alone [40 patients].and after the control of the disease the dose of prednisolone was reduced gradually ,till it was stopped, and patients were observed for relapse. there was no meaningful statistical difference between the two groups in the terms of relapse, as giving azathioprine did not reduce the relapse rate, and did not reduce the prednisolone dose needed to prevent relapse. in this study no use of azathioprine in preventing relapse in pemphigus vulgaris patients, so we advise for more studies to confirm that, and to give more attention during its prescription
RESUMO
Pemphigus vulgaris is a life threatening relapsing disease, the first line in its treatment is systemic steroids, and due to the high rate of side effects caused by systemic steroids in pemphigus vulgaris patients, some immunosuppressant drugs have been introduced as an adjuvant steroid sparing agents, and one of these immunosuppressants is methotrexate, and in spite of the lack of its use in pemphigus vulgaris, a few studies have shown an encouraging results of its use, and have advised to carry out more studies about it as an immunosuppressant which has been omitted from usage in pemphigus vulgaris for a long time. To study the advantage of adding low dose of methotrexate as an adjuvant therapy to prednisolone in moderate pemphigus vulgaris, and to compare the response with the response of prednisolone alone. 28 moderate pemphigus vulgaris patients have been studied, from the patients of the dermatology university hospital during the period between 29/8/2009 -29/8/2010 then the patients were followed-up for 18 months, they have been divided into 2 groups. The first: were treated with prednisolone plus methotrexate [13 patients], the second: were treated with prednisolone alone [15 patients]. The response has been Monitored and studied and after the control of the disease the dose of prednisolone was reduced gradually, till it was stopped, and patients were observed for relapse through the following year and a half. No significant difference statistically was observed between the two groups in the terms of achieving a good response [good response means by definition: the ceasing of the appearance of new lesions plus the recovery of 80% of established lesions], but the adding of methotrexate decreased the time in which the dermal lesions started to heal in a statically significant differance, as well it contributed in decreasing the relapse rate in a significant difference statistically with a limited side effects. methotrexate can be used as an adjuvant therapy in pemphigus vulgaris patients to reduce the relapse rate in those patients after desease control
RESUMO
Pephigus vulgaris is a recurrent life threatening disease. Its basic treatment is systemic steroids, after treating the first attack of the disease by systemic steroids we start to reduce the dose of the steroids gradually. During this reduction the desease may flare up, this recurrence is routinely treated by increasing the dose of the steroids again to control the disease, this study was made to compare the benefits of tetracycline in controlling the recurrence of pemphigus vulgaris with the routinely used way which is elevating the dose of prednisolone. this is a randomized controlled clinical trial where 38 patients of recurrent pemphigus vulgaris [during the period of reduction of steroids, mild to moderate recurrence], who visited the dermatology department in Damascus university between 29/12/2009-29/12/2010 ,were treated. they were divided into to groups :1-treatment with tetracycline [20 patients]:the dose of prednisolone which accompanied the recurrence was maintained and tetracycline was added [2 g / day].2-treatment with elevating the dose of prednisolone[18 patients]. The response and the side effects were studied .and the patients were followed up for at least 5 monthes after the treatment. good response was reported in 14 patients in the first group treated with tetracycline [70%], and in 14 patients in the second group treated with elevating the dose of prednisolone [77.78%]. So the response was equal in the 2 groups. And the response was faster in the first group [during 3 weeks only] while it was slower in the second group [it was as late as the 5th week in 2 patients]. The side effects of tetracycline were minimal and transit. while the side effects of steroids was less in the first group which treated with tetracycline [12 patients had side effects due to steroids while 8 patients didn't have any side effects of steroids] compared with the patients of the second group who were treated with elevating the dose of prednisolone [who had side effects of steroids in all of them '18 patients`]. tetracycline can be used in the rcurrance of pemphigus vulgaris which happened during the reduction of steroids with maintaining the dose of recurrence of prednisolone