Corticosteroids are the mainstay of treatment for
pemphigus. However, despite the introduction of adjuvant
therapy for PV, the mortality rate has remained static over the past 2 decades, and consequently, a new adjuvant
therapy that is both safe and effective is needed. Intravenous pulse
cyclophosphamide has shown encouraging results in few studies, with a better safety profile than the oral formulation, and with better treatment compliance. We undertook a randomized, prospective, non-blinded trial to assess the efficacy of
cyclophosphamide pulse
therapy (
CPT) as an adjuvant to oral
corticosteroid in
pemphigus vulgaris (PV). We enrolled 60 patients with mild to moderate active disease to receive either daily oral
prednisolone or intravenous
CPT prednisolone for 1 year, and they were then followed up for another year. At the end of the study period, the time taken to initiate response was similar in both groups, but in the group who received pulse
cyclophosphamide, there was a reduced time to remission, a greater proportion of cases who achieved remission, a lower number of patients who relapsed while on treatment or after stopping treatment, and a lower cumulative dose of
corticosteroid. Hence, the overall trend was in favour of
CPT, although this was not significant.
CPT also had a good safety profile. Based on the results of this trial,
CPT may be a useful adjuvant in PV in terms of reducing time to remission, relapse rates and cumulative dose of
steroid, and it has a good safety profile.