Terapia immunosoppressiva in boli (pulse therapy) nel pemfigo

Background. Pemphigus vulgaris (PV) had high mortality rates in the past but, thanks to the introduction of cortisone-based therapies, these have lowered considerably. However, prolonged use of these drugs leads to many undesirable side-effects, this is why therapies are associated with immunosuppressing agents. Methods. The present study used pulse therapy with methylprednisolone and cyclophosphamide at high doses in 17 patients. Thirteen cases had PV, 2 had pemphigus foliaceus (PF) and 2 had pemphigus seborrhoic (PS). Twelve patients were males and 5 females, with ages ranging from 24 to 73 years. Each patient underwent hematochemical tests, X-ray and scans designed to show possible pathologies for which this type of therapy is contraindicated. The patients underwent a variable number of cycles from 6 to 18. In 7 patients, from the onset of therapy and at every successive cycle, samples were tested for circulating antibodies. Follow-up on pemphigus patients treated in this way varied between a few months and 2 years. Results. Fourteen patients showed considerable improvement in clinical picture, and 2 patients with PF and 1 with PV showed no improvement. Evaluation of circulating antibodies resulted slightly lowered, but only 2 cases became negative. Conclusions. The good response to therapy showed in this study leads us to propose the above mentioned protocol, where possible, as an excellent alternative to continued, prolonged and exclusive use of cortisone-based therapy.