Document Detail

A comparison of oral methylprednisolone plus azathioprine or mycophenolate mofetil for the treatment of pemphigus.
MedLine Citation:
PMID:  17116835     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To investigate the safety and efficacy of oral methylprednisolone combined with azathioprine sodium or mycophenolate mofetil for the treatment of pemphigus.
DESIGN: A prospective, multicenter, randomized, nonblinded clinical trial to compare 2 parallel groups of patients with pemphigus (pemphigus vulgaris and pemphigus foliaceus) treated with oral methylprednisolone plus azathioprine or oral methylprednisolone plus mycophenolate mofetil. Settings Thirteen departments of dermatology in Germany. Patients We included patients with pemphigus vulgaris (n = 33) or pemphigus foliaceus (n = 7) evidenced by clinical lesions suggestive of pemphigus, intraepidermal blistering on histological analysis of skin biopsy specimens, intercellular deposition of IgG within the epidermis, and immunoblot analysis findings for antidesmoglein 3 and/or antidesmoglein 1 autoantibodies.
MAIN OUTCOME MEASURES: The cumulative total methylprednisolone doses and rate of remission. Secondary outcome measures were safety profiles and duration of remission.
RESULTS: In 13 (72%) of 18 patients with pemphigus receiving oral methylprednisolone and azathioprine, complete remission was achieved after a mean +/- SD of 74 +/- 127 days compared with 20 (95%) of 21 patients receiving oral methylprednisolone and mycophenolate mofetil in whom complete remission occurred after a mean +/- SD of 91 +/- 113 days. The total median cumulative methylprednisolone dose used was 8916 mg (SD, +/-29 844 mg) in the azathioprine group compared with 9334 mg (SD, +/-13 280 mg) in the mycophenolate group. In 6 (33%) of 18 patients treated with azathioprine, grade 3 or 4 adverse effects were documented in contrast to 4 (19%) of 21 patients who received mycophenolate mofetil. Conclusion Mycophenolate mofetil and azathioprine demonstrate similar efficacy, corticosteroid-sparing effects, and safety profiles as adjuvants during treatment of pemphigus vulgaris and pemphigus foliaceus.
Stefan Beissert; Thomas Werfel; Uta Frieling; Markus Böhm; Michael Sticherling; Rudolf Stadler; Detlev Zillikens; Berthold Rzany; Nicolas Hunzelmann; Michael Meurer; Harald Gollnick; Thomas Ruzicka; Hans Pillekamp; Volker Junghans; Thomas A Luger
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of dermatology     Volume:  142     ISSN:  0003-987X     ISO Abbreviation:  Arch Dermatol     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-11-22     Completed Date:  2006-12-15     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0372433     Medline TA:  Arch Dermatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1447-54     Citation Subset:  AIM; IM    
Department of Dermatology, University of Münster, Münster, Germany.
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MeSH Terms
Administration, Oral
Anti-Inflammatory Agents / administration & dosage*
Azathioprine / administration & dosage*
Disease-Free Survival
Drug Therapy, Combination
IMP Dehydrogenase / antagonists & inhibitors
Immunosuppressive Agents / administration & dosage*
Methylprednisolone / administration & dosage*
Middle Aged
Mycophenolic Acid / administration & dosage,  analogs & derivatives*
Pemphigus / drug therapy*,  mortality,  pathology
Prospective Studies
Severity of Illness Index
Treatment Outcome
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Immunosuppressive Agents; 24280-93-1/Mycophenolic Acid; 446-86-6/Azathioprine; 83-43-2/Methylprednisolone; 9242ECW6R0/mycophenolate mofetil; EC Dehydrogenase

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