Sukanjanapong Siriorn, Thongtan Darin, Kanokrungsee Silada, Suchonwanit Poonkiat, Chanprapaph Kumutnart
Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital-Mahidol University, Bangkok, Thailand.
Skin Center, Srinakharinwirot University, Wattana District, Bangkok, Thailand.
Dermatol Ther (Heidelb). 2020 Feb;10(1):179-189. doi: 10.1007/s13555-019-00346-x. Epub 2019 Dec 21.
Azathioprine (AZA) and mycophenolate mofetil (MMF) are both first-line steroid-sparing agents used for the treatment of pemphigus in combination with a corticosteroid, but few studies to date have directly compared these two combination treatment modalities. The aim of this study was to compare the efficacy and safety of each of these agents as adjuvant therapy with the corticosteroid prednisolone for the treatment of pemphigus, using standardized outcome parameters.
This was a retrospective study of patients with pemphigus who received corticosteroid therapy in combination with either AZA or MMF at the Autoimmune Blistering Skin Diseases Clinic of Ramathibodi Hospital (Bangkok) between January 2007 and July 2017. The treatment response was evaluated using early [end of the consolidation phase (ECP)] and late endpoints [complete remission (CR) on therapy, CR off therapy and immunological remission]. Cumulative steroid use, relapse rate and adverse events in each treatment group were also compared.
Of the 62 patients with pemphigus included in the study, 37 were treated with prednisolone plus AZA as adjuvant (AZA group) and 25 patients were treated with prednisolone plus MMF as adjuvant (MMF group). The majority of patients in both treatment groups reached the ECP (AZA group 88.2%; MMF group 71.4%; between-group difference not statistically significant at p = 0.156); the median time required to achieve this early endpoint was also comparable (p = 0.362). A high percentage of patients in both the AZA and MMF groups attained CR on therapy (AZA 73%; MMF 72%). The total number of patients who achieved CR on and off therapy were comparable in the two groups (p = 0.933 and p = 0.690, respectively). However, the median time for patients to achieve CR on therapy was significantly shorter for those on MMF than for those on AZA (7.3 vs. 12.5 months; p = 0.019), and the cumulative steroid dose required for patients to achieve CR both on and off therapy was significantly lower in the MMF group than in the AZA group (p = 0.007 and p = 0.043, respectively).
While corticosteroid in combination with either AZA or MMF is an effective therapeutic regimen for the treatment of pemphigus, MMF demonstrates a shorter time to achieve CR on therapy and has a significantly higher steroid-sparing effect.
硫唑嘌呤（AZA）和霉酚酸酯（MMF）均为一线糖皮质激素节约剂，用于与糖皮质激素联合治疗天疱疮，但迄今为止很少有研究直接比较这两种联合治疗方式。本研究的目的是使用标准化结局参数，比较这两种药物作为泼尼松龙辅助治疗天疱疮的疗效和安全性。
这是一项对2007年1月至2017年7月期间在拉玛蒂博迪医院（曼谷）自身免疫性水疱性皮肤病诊所接受糖皮质激素联合AZA或MMF治疗的天疱疮患者的回顾性研究。使用早期终点[巩固期结束（ECP）]和晚期终点[治疗期间完全缓解（CR）、治疗停药后CR和免疫缓解]评估治疗反应。还比较了每个治疗组的累积糖皮质激素使用量、复发率和不良事件。
本研究纳入的62例天疱疮患者中，37例接受泼尼松龙加AZA作为辅助治疗（AZA组），25例接受泼尼松龙加MMF作为辅助治疗（MMF组）。两个治疗组中的大多数患者达到了ECP（AZA组88.2%；MMF组71.4%；组间差异无统计学意义，p = 0.156）；达到这一早期终点所需的中位时间也相当（p = 0.362）。AZA组和MMF组中均有很高比例的患者在治疗期间达到CR（AZA组73%；MMF组72%）。两组中治疗期间和治疗停药后达到CR的患者总数相当（分别为p = 0.933和p = 0.690）。然而，MMF组患者在治疗期间达到CR的中位时间明显短于AZA组患者（7.3个月对12.5个月；p = 0.0
