JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2019 Month : April Volume : 6 Issue : 13 Page : 1078-1081

DEXAMETHASONE-CYCLOPHOSPHAMIDE PULSE THERAPY IN PEMPHIGUS- A CLINICAL STUDY

Yerrajwala Arunakumari1, Panthalla Vijayalakshmi2, Indukuri Chandrasekhar Reddy3

Corresponding Author:
Dr. Yerrajwala Arunakumari,
Flat 203, A Block,
S. V. Pride Apartment,
Birla Guest House Compound,
Kurnool, Andhra Pradesh.
E-mail: arunayerrajwala.kmc@gmail.com
DOI: 10.18410/jebmh/2019/225

ABSTRACT
BACKGROUND
Pemphigus is an autoimmune bullous disorder which was life threatening before the advent of steroids and immunosuppressants. Dexamethasone Cyclophosphamide Pulse Therapy introduced by Pasricha and Gupta in 1981 has lifelong recovery from the dreadful disease. We wanted to study the efficacy of DCP with certain modifications in pemphigus group of disorders.

METHODS
Irrespective of age, sex and severity of disease, 37 patients of pemphigus admitted between 2011 to 2014 who are being treated with DCP and followed for 2-5 years in department of DVL, GGH attached to medical college were included in the study. All patients completed the formalities and were investigated before and after the pulse. DCP regimen was repeated every 28 days with the cycle comprising of 100 mg of Dexamethasone in 500 ml of 5% glucose given intravenously for 3 consecutive days. 500 mg of cyclophosphamide given on Day 1. In between the pulses, 50 mg of oral cyclophosphamide given. Few modifications for better outcome were, additional dose of betamethasone to control disease activity in few severe cases, secondly, use of systemic antibiotics in all cases, anti candidal in cases with oral lesions, thirdly wound care, hygiene, nutritional supplements for fast healing.

RESULTS
All the patients were in remission. Number of pulses for remission in phase II varied from 11-22. 7 patients required additional 2 mg of oral betamethasone in Phase I. Additional use of mycophenolate mofetil was given in 2 cases with severe recalcitrant mucosal lesions instead of cyclophosphamide. Disease free follow up period was >5 years in 16 pts (45.71%), 3-5 years in 13 pts (37.14%), 2-3 years in 6 pts (17.14%). No deaths occurred in our study. 1 patient was withdrawn from study because of avascular necrosis of femur. Another patient relapsed after 2 years who has taken some native medicine and was found HBsAg positive, was given plain dexamethasone pulse in place of DCP.

CONCLUSION
Our study clearly established the efficacy of DCP with regard to bringing complete remission and improvement of quality of life. Additional use of betamethasone and MMF in selected cases will further help in complete clearance of lesions.