Oral Betamethasone-azathioprine pulse : a patient compliant modification of Dexamethasone cyclophosphamide pulse therapy for pemphigus
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 12
Abstract
Pemphigus vulgaris (PV) is an autoimmune vesicobullous disorder in India with a very high mortality rate (>90%) if untreated. Immunosuprresives are the mainstay of treatment. Dexamethasonecyclophosphamide pulse (DCP) therapy has also gained popularity in early remission in these patients. But it has also got some disadvantages. So we have modified the therapy with oral betamethasone and azathioprine. (1)To reduces loss of working hours of patients by giving a therapy requiring minimum hospital stay. (2) Reducing side effects and cost of DCP therapy. (3) Keeping the effectiveness of treatment at par with DCP therapy. A prospective, randomized study was carried out in a tertiary care setting in Kolkata among sixty - seven consecutive patients of pemphigus vulgaris & foliaceous attending the Dermatology OPD from February 2008 to December 2010. Like the original DCP therapy in our study also we have four phases. The first phase of remission in this study is for 12 months, the main changes being — (1) Use of oral betamethasone instead of injectable dexamethasone, (2) Use of azathioprine as steroid sparing drug instead of cyclophosphamide, (3) Home therapy for the last 6 pulses of phase. Sixty two patients completed the study; out of them 27 were males and 35 females. Forty eight patients achieved remission in 3 pulses, 7 patients needed up to 6 pulses and 7 patients needed more than 6 pulses (up to 17 pulses) to achieve remission. Recovery was noticed as early as one week in cutaneous lesions and 2 weeks in mucous lesions. Regular patients achieved remission early. Betamethasone Azathioprine Pulse Therapy is more acceptable to the pemphigus patients due to its flexibility regarding hospital attendance. It is cheaper, and at the same time it is at par in affectivity to other modalities of pulse therapy like DCP with lesser or same side effects.
Authors and Affiliations
Sudip Das, Suchibrata Das, Aloke Kr Roy, Loknath Ghoshal, Joyeeta Chowdhury, Sayantani Chakrabarty
Keywords
Related Articles
- EP ID EP618641
- DOI -
- Views 148
- Downloads 0
Critical care of acute stroke
In the last decade, there has been tremendous interest and growth in setting up ICUs and stroke centers across India. Because of changes in modern stroke therapy and advanced imaging techniques with software for remote r...
A delayed presentation of scheuermannÂ’s disease in a female
Low back pain is a common concern, affecting up to 90% of people at some point in their lifetime.Low back pain is not a specific disease, rather it is a symptom that may occur from a variety of different processes. Commo...
A case of early morning abnormal behavior and refractory epilepsy
Insulinomas are rare neuroendocrine tumors of pancreatic islet cells that retain the ability to produce and secrete inappropriately high insulin. The clinical symptoms of insulinoma are the subsequent to development of h...
Topical heparin for infusion associated superficial thrombophlebitis : A preventive approach
Maintaining a single indwelling intravenour (IV) catheter for a long duration is limited mainly due to the development of superficial thrombophlebitis. This, we decided to evaluate the efficacy and safety of heparin sodi...
Ovarian fibroma with minor sex cord elements an incidental finding
Ovarian fibroma with minor sex cord elements is rare tumor of benign nature with less than 20 cases reported till date. Our case was a 55yr old female, who presented with dysfunctional uterine bleeding and a solid ovaria...