Ali Asilian; Fariba Iraji; Saba Khalilian; Zabihollah Shahmoradi; Mina Saber
Abstract
Background: Psoriasis is an immune-mediated inflammatory disease with unclear pathophysiology. Although diverse medications have been applied, a paucity of knowledge is accessible regarding the use of corticosteroids for psoriasis management. We evaluated the efficacy of corticosteroid pulse therapy ...
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Background: Psoriasis is an immune-mediated inflammatory disease with unclear pathophysiology. Although diverse medications have been applied, a paucity of knowledge is accessible regarding the use of corticosteroids for psoriasis management. We evaluated the efficacy of corticosteroid pulse therapy in combination with methotrexate versus methotrexate alone for psoriasis treatment.Methods: This cohort study was conducted on 51 hospitalized patients with erythrodermic or pustular psoriasis who were assigned to one of the therapeutic interventions of subcutaneous methotrexate alone (n = 33) or in combination with betamethasone pulse therapy (n = 18). The first group was treated with weekly 15 mg subcutaneous methotrexate for six weeks, and the second group received a similar dose of methotrexate plus 3 mg oral betamethasone weekly. The patients were followed for six months and assessed regarding the disease remission, relapses, the interval between the medication and relapse incidence, and patient satisfaction with the regimens.Results: The studied groups were similar regarding gender (P = 0.296), age(P = 0.561), and the type of cutaneous lesions (P = 0.807). Six months follow-up of the two therapeutic interventions revealed insignificant differences in terms of early response to the treatment (P = 0.993), the incidence (P = 0.142) and frequency of relapses (P = 0.928), and the interval period between the treatment and relapse (P = 0.213). Besides, the patients’ treatment satisfaction did not differ between the groups (P = 0.453).Conclusion: Based on this study, combining methotrexate and lowdose corticosteroid pulse therapy does not lead to better outcomes than methotrexate alone for managing pustular and erythrodermic psoriasis. Further studies are strongly recommended.
Nafiseh Esmaily; Amirhooshang Ehsani; Pedram Noormohammadpour; Iman Baiagouy; Shima Sayanjali
Volume 13, Issue 4 , 2010, , Pages 118-121
Abstract
Background: Pemphigus vulgaris (PV) is a rare autoimmune blistering disease with a high rate of morbidity and mortality without treatment. Until now, treatments consist mostly of the use of corticosteroid and immunosuppressive drugs. Optimum dosage for corticosteroid therapy is yet to be determined. ...
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Background: Pemphigus vulgaris (PV) is a rare autoimmune blistering disease with a high rate of morbidity and mortality without treatment. Until now, treatments consist mostly of the use of corticosteroid and immunosuppressive drugs. Optimum dosage for corticosteroid therapy is yet to be determined. The aim of the present study was to clear whether different initial corticosteroid therapeutic dosages change the recurrence rate of the disease.Methods: Patients hospitalized with confirmed PV from 2000 to 2006 were enrolled if they received systemic corticosteroids without any adjuvant therapy for no more than three weeks when hospitalized, received their first treatment in the period of the study and were followed for at least two years in the PV clinic of Razi Hospital periodically. Initial steroid dosage as well as the number and type of the recurrence(s) were documented and analyzed.Results: A total of 62 patients with a mean age of 46.8 (± 15.9) were enrolled. Twenty-one patients were female (33.9%) and 41 patients (66.1%) were male. According to the initial dose of systemic corticosteroid, patients were divided into two groups: group A included patients treated with less than 2mg/kg (10 patients or 16.1%) while group B included patients treated with 2mg/kg systemic steroids (52 patients or 83.9%). There was no significant difference in the recurrence rate between the two groups. Recurrence rate was 40% in group A and 51% in group B (P>0.05). According to the type of recurrence, there was a significant difference between the two groups; in group A, the first recurrence was major in 33% of the patients while in group B, this rate was about 28.8% (P<0.05).Conclusion: According to the present study, initial therapeutic dosage did not influence the recurrence rate although the type of recurrence was influenced. Patients treated with higher initial steroid dosages experienced their first episode as a minor recurrence while patients treated with lower initial steroid dosages experienced major recurrences with a higher probability as their first episode.