Mignogna Michele Davide, Lo Muzio Lorenzo, Ruoppo Elvira, Fedele Stefano, Lo Russo Lucio, Bucci Eduardo
Division of Oral Medicine, Department of Odontostomatological and Maxillo-Facial Sciences, School of Dentistry, University of Naples, Federico II, Naples, Italy.
J Oral Pathol Med. 2002 Jul;31(6):339-44. doi: 10.1034/j.1600-0714.2002.00085.x.
High-dose intravenous (i.v.) methylprednisolone has been used therapeutically in severe blistering diseases to avoid the complications and side-effects of long-term orally administered glucocorticoid therapy. The aim of the study is to evaluate the capacity of methylprednisolone i.v. 'pulse' therapy to induce remission in the treatment of severe oropharyngeal pemphigus.
Twelve patients, all of whom had oropharyngeal severe pemphigus, were included in the analysis. There were eight women and four men whose ages ranged from 22 to 78 years (mean age: 50.75 years) with a disease duration of 1-3 months(mean duration: 55 days). In order to obtain a rapid clinical remission of extensive mucosal lesions, we performed 'pulse' therapy with intravenous methylprednisolone (30 mg/kg body weight to a maximum of 1 g per dose on each of 3-5 consecutive days)evaluating the clinical response and the short-term side-effects.
Our therapy was generally safe and well tolerated with a very low rate of side-effects. All patients responded to i.v. methyl-prednisolone with evidence of a decrease in signs and symptoms within l week of commencing treatment and in all cases remission was observed after the second or the third cycle of 'pulse'. The most common adverse events during treatment were flushing and hyperglycaemia; in a few cases we observed a metallic taste in the mouth, pruritus, headaches ranging from mild to moderate, palpitations, mood alterations, insomnia and fatigue.
High-dose 'pulse' administration of glucocorticoids is a potentially effective therapy to be considered in the treatment of patients with severe oropharyngeal pemphigus. Similar patients treated with conventional oral administered doses of prednisone or deflazacort had protracted courses requiring months of glucocorticoid therapy with no long-term remissions. However, further well-designed, long-term comparative trials are required to confirm this.
大剂量静脉注射甲基泼尼松龙已被用于治疗严重水疱性疾病，以避免长期口服糖皮质激素治疗的并发症和副作用。本研究的目的是评估静脉注射甲基泼尼松龙“冲击”疗法诱导重度口腔咽喉部天疱疮缓解的能力。
分析纳入了12例均患有口腔咽喉部重度天疱疮的患者。其中有8名女性和4名男性，年龄在22至78岁之间（平均年龄：50.75岁），病程为1至3个月（平均病程：55天）。为了使广泛的黏膜病变迅速获得临床缓解，我们采用静脉注射甲基泼尼松龙进行“冲击”疗法（连续3至5天，每天每千克体重30毫克，最大剂量为每次1克），评估临床反应和短期副作用。
我们的治疗总体安全且耐受性良好，副作用发生率极低。所有患者对静脉注射甲基泼尼松龙均有反应，在开始治疗后1周内体征和症状有减轻迹象，并且在所有病例中，在第二个或第三个“冲击”周期后均观察到缓解。治疗期间最常见的不良事件是潮红和高血糖；在少数情况下，我们观察到口腔中有金属味、瘙痒、轻度至中度头痛、心悸、情绪改变、失眠和疲劳。
大剂量糖皮质激素“冲击”给药是治疗重度口腔咽喉部天疱疮患者时可考虑的一种潜在有效疗法。用传统口服剂量的泼尼松或地夫可特治疗的类似患者病程迁延，需要数月的糖皮质激素治疗且无长期缓解。然而，需要进一步设计良好的长期对照试验来证实这一点。
