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Controlled study of plasma exchange in pemphigus
J C Guillaume1, J C Roujeau, P Morel
1Department of Dermatology, Hôpital Henri Mondor, Université Paris XII, France.
Archives of Dermatology
|November 1, 1988
Summary
Plasma exchange did not improve steroid sparing in pemphigus patients and was associated with increased sepsis risk. This treatment combination is not recommended for pemphigus management.
Area of Science:
- Dermatology
- Immunology
- Critical Care Medicine
Background:
- Pemphigus is a severe autoimmune blistering disease.
- Steroids are the mainstay of treatment, but carry significant side effects.
- Investigating steroid-sparing agents like plasma exchange is crucial.
Observation:
- A multicenter randomized study compared prednisolone alone versus prednisolone plus plasma exchange in 40 pemphigus patients.
- Both groups received identical initial prednisolone dosages, adjusted weekly as needed.
- Disease control rates, cumulative steroid doses, and antibody titers were similar between groups.
Findings:
- Plasma exchange did not demonstrate a steroid-sparing effect in pemphigus treatment.
- Four deaths from sepsis occurred in the plasma exchange group, compared to none in the control group.
- No significant difference was observed in disease control or antibody levels.
Implications:
- Plasma exchange in conjunction with low-dose steroids is ineffective for pemphigus.
- This combination therapy may increase the risk of serious infections like sepsis.
- Alternative or adjunctive therapies for pemphigus should be explored.