Dexamethasone-cyclophosphamide pulse therapy outcomes comparing pemphigus vulgaris and pemphigus foliaceus groups in a Brazilian cohort study

Fontenelle, Ludmilla Figueiredo; Bueno-Filho, Roberto; Vernal, Sebastián; Delfino, Renata; Barbosa, Giovanna Stefanne Lópes; Donadi, Eduardo Antonio; Roselino, Ana Maria

doi:10.1016/j.abd.2022.11.005

Ludmilla Figueiredo Fontenelle

Data collection

analysis

and interpretation

statistical analysis

writing of the manuscript

effective participation in the research guidance

critical review of the literature

final approval of the final version of the manuscript.

Department of Medical Clinics, Hospital Universitário, Universidade de São Paulo, Ribeirão Preto, SP, Brazil

Department of Medicine, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil

http://orcid.org/0000-0003-4885-8340

Roberto Bueno-Filho

Analysis and interpretation

critical review of important intellectual content

final approval of the final version of the manuscript.

Department of Medical Clinics, Hospital Universitário, Universidade de São Paulo, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0003-2871-0306

Sebastián Vernal

Analysis and interpretation

critical review of important intellectual content

final approval of the final version of the manuscript.

Department of Medical Clinics, Hospital Universitário, Universidade de São Paulo, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0001-8589-0089

Renata Delfino

Data collection

analysis

and interpretation

final approval of the final version of the manuscript.

Department of Medical Clinics, Hospital Universitário, Universidade de São Paulo, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0002-2143-9050

Giovanna Stefanne Lópes Barbosa

Analysis and interpretation

critical review of important intellectual content

final approval of the final version of the manuscript.

Department of Medicine, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil

http://orcid.org/0000-0003-3387-1219

Eduardo Antonio Donadi

Analysis and interpretation

critical review of important intellectual content

final approval of the final version of the manuscript.

Department of Medical Clinics, Hospital Universitário, Universidade de São Paulo, Ribeirão Preto, SP, Brazil

Department of Medical Clinics, Universidade de São Paulo, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0002-9457-9601

Ana Maria Roselino ^⁎⁎ Corresponding author. E-mail: amfrosel@fmrp.usp.br (A.M. Roselino).

Study concept and design

critical review of important intellectual content

effective participation in the research guidance

critical review of the literature

final approval of the final version of the manuscript.

Department of Medical Clinics, Hospital Universitário, Universidade de São Paulo, Ribeirão Preto, SP, Brazil

Department of Medical Clinics, Universidade de São Paulo, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0002-2709-1825

⁎ Corresponding author. E-mail: amfrosel@fmrp.usp.br (A.M. Roselino).

Conflicts of interest

None declared.

	PV	PF	p-value
	n = 37	n = 41	p-value
Gender, n (%)			0.819
Male	14 (37.8)	17 (41.5)
Female	23 (62.2)	24 (58.5)
Age (years) median (min‒max)	42 (16‒69)	21 (11‒85)	<0.001
Patients under 18 years, n (%)	2 (5.4)	10 (24.4)	0.028
Disease duration before pulse therapy (months) median (min‒max)	14 (2‒92)	69 (2‒528)	<0.001
Pulse therapy as first treatment, n (%)	5 (13.6)	None	0.055
DCP	4 (10.8)	None
DP	1 (2.7)	None
Previous treatment, n (%)^a a Patients were treated with more than one drug.	32 (86.5)	41 (100)
Prednisone	31 (83.8)	40 (97.6)
Dapsone	15 (40.5)	12 (29.3)
Hydroxychloroquine	1 (2.7)	14 (34.1)
Azathioprine	7 (18.9)	9 (22.0)
Methotrexate	1 (2.7)	8 (19.5)
Pulse therapy regimen n (%)			0.235
DCP	27 (73.0)	24 (58.5)
DP	10 (27.0)	17 (41.5)

	PV (n = 37)	PF (n = 41)	p-value
	n (%)	n (%)	p-value
Phase I	37 (100)	41 (100)
Remission, followed to Phase II	25 (67.6)	23 (56.1)	0.355
Failure	5 (13.5)	6 (14.6)	1.0
Abandonment	4 (10.8)	5 (12.2)	1.0
Clinical intercurrences	2 (5.4)	4 (9.7)	0.678
Continuing therapy^a a Patients who still were in Phases I, II or III at data collection time; N.A., Not Applicable.	1 (2.7)	3 (7.3)	N.A.
Pulses to remission, median (min-max)	6 (1-18)	10 (2-33)	0.005
Months to remission, median (min‒max)	5 (1‒19)	11 ( 2‒3 3)	0.002
Pulses to failure, median (min-max)	13 (11-24)	25 (16-34)	0.074
Phase II	25 (100)	23 (100)
Maintained remission, follow to Phase III	21 (84.0)	19 (82.6)	1.0
Relapse	1 (4.0)	None	1.0
Abandonment	1 (4.0)	None	1.0
Clinical intercurrences	1 (4.0)	1 (4.4)	1.0
Continuing therapy^a a Patients who still were in Phases I, II or III at data collection time; N.A., Not Applicable.	1 (4.0)	3 (13.0)	N.A.
Phase III	21 (100)	19 (100)
Maintained remission, follow to Phase IV	18 (85.7)	19 (100)	1.0
Abandonment	2 (9.5)	None	0.493
Clinical intercurrences	None	None	1.0
Relapse	1 (4.8)	1 (5.3)	1.0
Continuing therapy^a a Patients who still were in Phases I, II or III at data collection time; N.A., Not Applicable.	1 (4.8)	None	N.A.
Phase IV	17 (100)	18 (100)
Remission off-therapy	14 (82.4)	14 (77.8)	1.0
Relapse	3 (17.6)	4 (22.2)	1.0
Time to relapse (months), median (min-max)	3 (2-3)	3 (1-47)	0.971
Follow-up duration (months), median (min-max)	12 (8-44)	26 (8‒56)	0.07

	Pemphigus vulgaris			Pemphigus foliaceus
	Remission off-therapy	Failure in Phase I	p-value	Remission off-therapy	Failure in Phase I	p-value
	n = 14	n = 5	p-value	n = 14	n = 6	p-value
Gender (n)			0.631			0.161
Male	4	2		4	4
Female	10	3		10	2
Median (min-max)
Age (years)	50.5 (18-61)	36 (16-48)	0.031	23 (11-45)	36 (13-61)	0.247
Disease duration before pulse therapy (months)	14 (3-45)	11 (3-34)	0.374	81 (8--528)	114 (5-162)	0.999
Number of pulses in Phase I	6.5 (2-18)	13 (11-24)	0.002	10.5 (3-33)	25 (16-34)	0.004
Phase I duration (months)	5.5 (2-19)	19 (10-33)	0.002	12 (4-33)	29.5 (22-51)	0.003

	PV	PF	p-value
	n = 14	n = 14	p-value
Gender (n)			1.00
Male	4	4
Female	10	10
Median (min-max)
Age (years)	50.5 (18-61)	23 (11-45)	<0.001
Disease duration before pulse therapy (months)	14 (3-45)	81 (8-528)	0.006
Number of pulses in phase I	6.5 (2-18)	10.5 (3-33)	0.026
Phase I duration (months)	5.5 (2-19)	12 (4-33)	0.015
Follow-up duration in phase IV (months)	12 (8-44)	26 (8-56)	0.070

[1] ⁎ Corresponding author. E-mail: amfrosel@fmrp.usp.br (A.M. Roselino).

Brasil

Brasil

Abstract

Background

Objective

Methods

Results

Study limitations

Conclusions