Retrospective analysis of efficacy and safety of minocycline alone or in combination with low-dose glucocorticoids in the treatment of 15 cases of pemphigus erythematosus and 9 cases of pemphigus herpetiformis / 中华皮肤科杂志

ABSTRACT

Objective:To investigate the efficacy and safety of minocycline alone or in combination with low-dose glucocorticoids in the treatment of pemphigus erythematosus and pemphigus herpetiformis, as well as their effect on immune indices.Methods:A retrospective study was conducted, and patients with newly diagnosed pemphigus erythematosus or pemphigus herpetiformis, who received initial treatment with minocycline alone or in combination with low-dose glucocorticoids and were followed up for more than 6 months, were collected from Department of Dermatology, Peking University First Hospital from June 2011 to June 2021. Data on patients′ condition and autoantibody levels were collected at baseline and different follow-up time points, and disease severity, diagnosis, changes in autoantibody levels and their relationships with efficacy were analyzed. The Kaplan-Meier method was used to analyze complete remission rate, and chi-square test to analyze the efficacy among patients with different disease severity or after different treatments.Results:A total of 24 patients of Han nationality were collected and followed up for a median period of 21.8 months, including 15 with pemphigus erythematosus and 9 with pemphigus herpetiformis. The male to female ratio was 1.4∶1, their median age was 68.8 years, and the median duration of disease was 22.1 months. All the 24 patients achieved disease control, and the time to disease control ( M [ Q1, Q3]) was 15.9 (12, 20.1) weeks. Twenty-three (95.8%) patients achieved complete remission, and the time to complete remission was 8.7 (6.4, 10) months. After 1-year treatment, no significant difference in the complete remission rate was observed between patients receiving minocycline monotherapy (11/13) and those receiving combination therapy with low-dose glucocorticoids (9/11, χ2 = 0.16, P = 0.692) . During the follow-up period, 2 patients (8.7%) experienced recurrence in disease control state, 1 of whom achieved complete remission at week 38 after dose adjustment, and the other achieved complete remission after half-a-year treatment with rituximab. There was no significant difference in the efficacy between patients with mild and moderate pemphigus ( χ2 = 0.28, P = 0.599) . Drug-related adverse reactions occurred in 3 cases, including 1 case of tinea corporis on the back and 2 cases of generalized hyperpigmentation of the skin and gingiva. Conclusion:Minocycline alone or in combination with low-dose glucocorticoids was effective for the treatment of mild to moderate pemphigus erythematosus and pemphigus herpetiformis without serious adverse reactions, but long-term efficacy, adverse reactions and patients′ prognosis should be re-evaluated in prospective multi-center studies with a large sample size in the future.