Dexamethasone-cyclophosphamide pulse therapy in pemphigus: A 5-year retrospective study

Abstract

Objective The present work was conducted to assess the outcome of dexamethasone-cyclophosphamide pulse (DCP) therapy in pemphigus.  Methods The present work was designed as a retrospective tertiary urban hospital based, observational study during the period from Jan 2012 to Dec 2016. Data regarding clinical details about the disease, previous treatments, phases of therapy, remission, relapse, cure, default and reasons for default, death and causes of death and adverse effects of therapy were evaluated. Results Out of 102 patients of pemphigus on DCP therapy, majority (n=42) of them belonged to age group of 40 to 49years. Mean age of patients was 42.08 years with a range of 24 to 65 years. Male to female ratio was 1:1.48. Of the 102 patients, 30 patients were in phase I, 23 were in phase II, 12 were in phase III and 37 were in phase IV. Mean number of pulses required for remission, that is, for completion of phase I were 5.2 months (range, 2-15 months). Majority (n=47, 65.3%) of them needed 4-7 pulses to achieve remission. Among 72 patients who achieved remission, a total 15 patient relapsed.  Infusion-related reactions were the most common immediate adverse effect and generalized weakness/malaise were the most common delayed adverse effect recorded. Nine (7.7%) patients died while on DCP therapy and the most common (n=5) cause of death was septicaemia. Conclusion The DCP therapy was found to be effective in inducing and maintaining remission in pemphigus, provided the patients receive regular and complete treatment. The cost-effectiveness is definitely superior to other treatment modalities (biologics), which is of utmost importance in our setup as majority of patients belonged to poor socioeconomic strata, although the relapse rate and mortality rate were higher compared to other studies.