Immunosuppressive therapy of patients with pemphigus with ineffectiveness of systemic corticosteroids

Therapy of patients with pemphigus vulgaris with systemic corticosteroids may not be effective enough or lead to the development of severe adverse events that make it necessary to reduce the dose of corticosteroid. In such cases, it is possible to use the immunosuppressants. The literature review analyzes case reports and the results of studies that evaluated the effectiveness and safety of drugs used for immunosuppressive therapy of patients with pemphigus vulgaris. The drugs doses, the studies design, and criteria for evaluating the effectiveness of therapy in patients with pemphigus are considered. As a result of the analysis, it was shown that case reports and non-compatarive studies demonstrate the effectiveness and steroid-sparing effect of azathioprine, dapsone, methotrexate, mycophenolate mofetil, cyclosporine and cyclophosphamide in the treatment of patients with pemphigus vulgaris. Nevertheless, comparative studies show an increase in the effectiveness of therapy in patients with pemphigus and a faster achievement of therapeutic effect when prescribing cyclophosphamide, but not azathioprine, dapsone, methotrexate, mycophenolate mofetil or cyclosporine. However, the toxicity of cyclophosphamide limits its use in pemphigus. Thus, adjuvant drugs can be used in the treatment of patients with pemphigus in situations where it is not possible to reduce the dose of a systemic corticosteroid, especially in cases of severe adverse events of corticosteroid therapy.