Improved protocol for treatment of pemphigus vulgaris with protein A immunoadsorption
2006; Oxford University Press; Volume: 31; Issue: 6 Linguagem: Inglês
10.1111/j.1365-2230.2006.02220.x
ISSN1365-2230
AutoresIakov Shimanovich, S. Herzog, Enno Schmidt, Andreas Opitz, Erdwine Klinker, Bröcker Eb, Matthias Goebeler, Detlef Zillikens,
Tópico(s)Oral and gingival health research
ResumoClinical and Experimental DermatologyVolume 31, Issue 6 p. 768-774 Improved protocol for treatment of pemphigus vulgaris with protein A immunoadsorption I. Shimanovich, I. Shimanovich Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorS. Herzog, S. Herzog Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorE. Schmidt, E. Schmidt Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorA. Opitz, A. Opitz Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorE. Klinker, E. Klinker Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorE-B. Bröcker, E-B. Bröcker Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorM. Goebeler, M. Goebeler Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorD. Zillikens, D. Zillikens Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this author I. Shimanovich, I. Shimanovich Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorS. Herzog, S. Herzog Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorE. Schmidt, E. Schmidt Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorA. Opitz, A. Opitz Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorE. Klinker, E. Klinker Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorE-B. Bröcker, E-B. Bröcker Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorM. Goebeler, M. Goebeler Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this authorD. Zillikens, D. Zillikens Department of Dermatology, University of Lübeck, Germany; Departments of *Dermatology and †Transfusion Medicine, University of Würzburg, Germany; and ‡Department of Dermatology, University Hospital Mannheim, University of Heidelberg, GermanySearch for more papers by this author First published: 04 July 2006 https://doi.org/10.1111/j.1365-2230.2006.02220.xCitations: 41 Dr Detlef Zillikens, Department of Dermatolgy, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.E-mail: detlef.zillikens@uk-sh.deThe first two authors contributed equally to this work. Conflict of interest: none declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Summary Background. Pemphigus vulgaris is a life-threatening autoimmune blistering skin disease, usually treated with high-dose corticosteroids in combination with other immunosuppressants. However, this regimen may prove inadequate in severe cases and can cause dangerous side-effects. We have recently reported protein A immunoadsorption (PAIA) to be an effective adjuvant treatment for induction of remission in severe pemphigus. However, in a significant number of cases, the disease rapidly recurred once PAIA and immunosuppressive medication were tapered. Aims. The aim of the present study was to develop a PAIA-based therapeutic regimen that would result in a more prolonged remission of pemphigus. Methods. Nine patients with pemphigus vulgaris were treated with a modified protocol characterized by a combination of PAIA with a higher initial dose of systemic methylprednisolone (2 mg/kg). In addition, azathioprine or mycophenolate mofetil was administered as a steroid-sparing agent. Results. In all nine patients treated with this regimen, we observed a sharp decline of circulating autoantibody levels and dramatic improvement of cutaneous and mucosal lesions within 4 weeks of therapy. The patients remained free of clinical disease for up to 26 months after PAIA treatment was discontinued. Conclusion. The improved treatment protocol appears to combine highly effective induction of clinical remission in severe or treatment-resistant pemphigus with a prolonged subsequent symptom-free interval. Citing Literature Volume31, Issue6November 2006Pages 768-774 RelatedInformation
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