Assessment of the rate of long-term complete remission off therapy in patients with pemphigus treated with different regimens including medium- and high-dose corticosteroids - 13/07/13

Doi : 10.1016/j.jaad.2013.05.016

Naif Almugairen, MD ^a, Valerie Hospital, MD ^c, Christophe Bedane, MD, PhD ^d, Sophie Duvert-Lehembre, MD ^a, Damien Picard, MD, PhD ^a, Anne-Fleur Tronquoy, MD ^a, Estelle Houivet, MD ^b, Michel D'incan, MD, PhD ^c, Pascal Joly, MD, PhD ^a,^⁎
^a Department of Dermatology, INSERM U 905, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, University of Rouen, Rouen, France
^b Department of Biostatistics, Rouen University Hospital, University of Rouen, Rouen, France
^c Department of Dermatology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
^d Department of Dermatology, Limoges University Hospital, Limoges, France

^∗Reprint requests: Pascal Joly, MD, PhD, Clinique Dermatologique, Rouen University Hospital, 1 Rue de Germont, F 76031 Rouen cedex, France.

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 13 July 2013

Abstract

Background

Few studies have evaluated pemphigus treatments according to the definitions of the consensus statement. Prognostic factors for complete remission off therapy (CRoffT) remain unknown.

Objective

We sought to assess the rate of CRoffT in patients with pemphigus treated with different regimens.

Methods

In all, 134 patients with pemphigus were included in a retrospective, multicenter study. Primary end point was the rate of CRoffT. Prognostic factors for CRoffT were determined using univariate and multivariate analyses.

Results

Eighty patients with pemphigus vulgaris, 47 with pemphigus foliaceus, and 7 with paraneoplastic pemphigus were included. Mean age was 60 ± 18 years. Patients were treated either with medium (≤0.5 mg/kg/d) (n = 32) or high (≥1 mg/kg/d) (n = 59) doses of prednisone, or without systemic corticosteroids (n = 43). Mean follow-up was 77 ± 64 months. In all, 68 patients (50.7%) achieved CRoffT (95% confidence interval 42.3%-59.2%) after a mean treatment duration of 36 ± 39 months, including 47 of 80 patients with pemphigus vulgaris (58.7%) and 21 of 47 with pemphigus foliaceus (44.7%). Main prognostic factors for CRoffT were initial mucosal involvement (hazard ratio 2.2; 95% confidence interval 1.05-4.58; P = .036) and younger age (<61 years) (hazard ratio 2.5; 95% confidence interval 1.18-5.12; P = .0167). The rate of long-lasting CRoffT was 44%, with a mean follow-up after treatment withdrawal of 59 ± 50 months.