Remission in pemphigus vulgaris with strategic steroid tapering

(HealthDay)—For patients with pemphigus vulgaris, a severity-tailored starting dose of glucocorticoids with an initial tapering duration based on the starting dose and a subsequent 50 percent yearly tapering regimen can result in complete remission within three to six years, according to a study published online Sept. 1 in the Journal of Dermatology.

Mingyue Wang, M.D., Ph.D., from Peking University First Hospital in Beijing, and colleagues summarized a therapeutic schedule with glucocorticoids in 140 patients with pemphigus vulgaris.

The researchers found that 124 patients achieved complete remission off or on a prednisone dose of ≤10 mg/day for six months or more. For mucosal-dominant patients, and the mild, moderate, severe, and extensive cutaneous-involved patients, the mean average steroid controlling doses were 0.65, 0.62, 0.80, 1.08, and 1.38 mg/kg per day, respectively (P < 0.001). For the cutaneous-involved types, the mean durations of the initial tapering after controlled doses started were 77.98, 48.78, 31.74, and 28.83 days when the disease was controlled with doses of 40 or less, 45 to 60, 65 to 80, and more than 80 mg/day, respectively (P < 0.005). Overall, complete remission was achieved by 79.51 percent within three years, 98.36 percent within five years, and in all patients within six years, corresponding to a 50 percent yearly reduction in glucocorticoid dose.

"A strategy involving categorized initial doses and initial tapering followed by a 50 percent-off yearly reduction regimen is practical and effective for treating pemphigus vulgaris with glucocorticoids," the authors write.

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