Which First-Line Steroid-Sparing Adjuvant Therapy Is Effective for Pemphigus?

Rituximab may be an effective add-on therapy for patients with pemphigus, according to the findings of a recent network meta-analysis.

According to the researchers, steroid-sparing adjuvants may enhance the benefits of oral glucocorticoid among patients with pemphigus. However, “selecting the optimal therapeutic option among various first-line steroid-sparing adjuvants is often a clinical challenge due to the lack of head-to-head clinical trials,” they noted.

In the meta-analysis, the researchers identified 10 randomized control trials that compared a total of 7 different steroid-sparing adjuvants among 592 patients with pemphigus. They assessed the proportion of patients who achieved remission and the mean cumulative glucocorticoid dose as the primary outcomes.
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Rituximab was found to be the most effective steroid-sparing adjuvant for achieving remission and was more effective than steroid therapy alone (odds ratio, 14.35; 95% CI, 4.71-43.86). Also, rituximab, azathioprine, and cyclophosphamide pulse therapy were associated with reductions in cumulative doses of glucocorticoids compared with steroid therapy alone.

“Network meta-analysis demonstrated that rituximab appears to be an efficacious and safe steroid-sparing adjuvant for pemphigus,” the researchers concluded.

The limitations of this study were that the results were driven by a small number of studies and the effect estimates were imprecise due to indirect comparisons.

Reference

Lee MS, Yeh YC, Tu YK, Chan TC. Network meta-analysis-based comparison of first-line steroid–sparing adjuvants in treatment of pemphigus vulgaris and pemphigus foliaceus. J Am Acad Dermatol. Published online August 12, 2020. doi:10.1016/j.jaad.2020.08.028