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Immunosuppressive therapy for autoimmune bullous diseases.

Abstract
Adjuvant immunosuppressive drugs are widely used to minimize corticosteroid-related adverse effects in the short-term and long-term management of cautoimmune bullous diseases. In bullous pemphigoid and pemphigus vulgaris, azathioprine and mycophenolate mofetil seem to be equally effective when used in combination with oral corticosteroids, but mycophenolate mofetil is less myelosuppressive and hepatotoxic. Due to a better safety profile, mycophenolate mofetil or enteric-coated mycophenolate sodium may gradually replace azathioprine as the first-line adjuvant of choice in the treatment of moderate to severe autoimmune bullous diseases, including epidermolysis bullosa acquisita and cicatricial pemphigoid. Cyclophosphamide still has a place in the treatment of severe relapsing autoimmune bullous diseases. Continuous oral cyclophosphamide provides optimal immunosuppression, but it also produces the highest cumulative dose. Several pulsed cyclophosphamide regimens have, therefore, been developed and are reported to be effective in severe forms of pemphigus. Randomized controlled studies are needed to compare the efficacy and safety of cyclophosphamide with newer treatment options, such as rituximab and immunoapheresis, and to define optimal dose ranges and duration of available immunosuppressive treatments in different stages of autoimmune bullous diseases.
AuthorsMichael Meurer
JournalClinics in dermatology (Clin Dermatol) 2012 Jan-Feb Vol. 30 Issue 1 Pg. 78-83 ISSN: 1879-1131 [Electronic] United States
PMID22137230 (Publication Type: Journal Article, Review)
CopyrightCopyright © 2012 Elsevier Inc. All rights reserved.
Chemical References
  • Glucocorticoids
  • Immunosuppressive Agents
  • Cyclophosphamide
  • Mycophenolic Acid
  • Azathioprine
Topics
  • Azathioprine (administration & dosage, adverse effects)
  • Cyclophosphamide (administration & dosage, adverse effects)
  • Dose-Response Relationship, Drug
  • Glucocorticoids (adverse effects)
  • Humans
  • Immunosuppressive Agents (administration & dosage, adverse effects)
  • Mycophenolic Acid (administration & dosage, adverse effects, analogs & derivatives)
  • Pemphigoid, Bullous (drug therapy)
  • Remission Induction
  • Severity of Illness Index
  • Skin Diseases, Vesiculobullous (drug therapy)
  • Treatment Outcome

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