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Czernik A, Bystryn J. Kinetics of Response to Conventional Treatment in Patients With Pemphigus Vulgaris. Arch Dermatol. 2008;144(5):682–683. doi:10.1001/archderm.144.5.682
It is difficult to evaluate the effectiveness of new therapies for pemphigus vulgaris (PV) because controlled trials are rarely performed. Comparison to historical trials is also problematic because little is known about the frequency and time it takes for active pemphigus to respond to conventional treatment.1,2 To address this problem, we evaluated the kinetics of response in PV to conventional treatment with prednisone.
A retrospective study was conducted in 29 sequential patients with PV based on clinical, histological, and immunofluorescence criteria. All patients met the following inclusion criteria: (1) they had experienced a flare in disease activity (≥ 3 new lesions per week) while undergoing treatment with stable or tapering doses of prednisone; (2) they had been treated only with systemic steroids prior to the flare; and (3) the flare was treated only with prednisone. The median disease duration was 7 months (range, 2 months to 11 years). The median prednisone dose at the time of the flare was 2.5 mg/d (range, 0-32 mg/d). Patients were treated by increasing the dose of prednisone in steps of 10 to 20 mg/d every 1 to 2 weeks until disease activity was controlled (<1 new lesion per week). No adjuvant therapy was added. The dose that controlled disease activity was maintained until approximately 80% of the lesions were healed (end of consolidation phase), at which point the dose was gradually tapered, usually by 5 mg every 2 to 3 weeks.
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