Azathioprine pulse therapy in the treatment of psoriasis
Keywords:
Azathioprine, azathioprine pulse therapy, APT, psoriasis, methotrexateAbstract
Objective To document the efficacy and safety of azathioprine pulse therapy in the treatment of psoriasis. Patients and methods Thirty five patients (group A) were given azathioprine pulse therapy (APT) which consisted of azathioprine 500 mg orally on 3 consecutive days and repeated every month. In between low dose azathioprine (100mg) daily was given. The entire treatment was divided into four phases. In phase I, APT was continued till clearance of all the lesions. In phase II (phase of remission), APT was given for another 9 months. In phase III, if there was no recurrence, high dose azathioprine was stopped and patient continued only daily low dose (100mg) azathioprine for another 9 months. In phase IV low dose azathioprine was also stopped and patients were followed up for any relapse. Another 35 patients (group B) were given methotrexate 15mg weekly orally along with coal tar ointment till complete clearances of the lesions. Results 30 out of 35 (85.7%) patients in group A are in clinical remission without any treatment with 5 patients lost to follow-up. 30 patients who are in phase IV, 21 are in continuous remission for more than 3 years, 6 for 1-3 years while 3 for less than 1 year after all the treatment was stopped. In group B, all patients relapsed after remission period of 91.78+14.19 days. Conclusion Thus azathioprine` pulse therapy has shown promising result with no recurrence of lesions for 40.14+22.56 months.ÂReferences
Feldman S. Advances in psoriasis treatment. Dermatol Online J. 2011;6:1-7.
Gupta R, Gupta S. Methotrexate betamethasone weekly oral pulse in psoriasis. J Dermatol Treat. 2007;18:291-4.
Levell NJ, Shuster S, Munro CS, Friedman PS. Remission of ordinary psoriasis following a short clearance course of cyclosporine. Acta Derm Venereol. 1995;75:65-9.
Lee CS, Koo J. A review of acitretin, a systemic retinoid for the treatment of psoriasis. Expert Opin Pharmacother. 2005;6:1725-34.
Brown BC, Warren RB, Grindlay JC, Griffiths CEM. What’s new in psoriasis? Analysis of the clinical significance of systemic reviews on psoriasis published in 2007 and 2008. Clin Exp Dermatol. 2009;34:664-7.
Koo J, Lebwohl M. Duration of remission of psoriasis therapies. J Am Acad Dermatol. 1999;41:51-9.
Ahmed AR, Moy R. Azathioprine. Int J Dermatol. 1981;20:461-7.
Kravetz RE, Balsam T. Treatment of psoriasis with mercaptopurine. Arch Dermatol. 1961;84:113-6.
Greaves MW, Dawber R. Azathioprine in psoriasis. Br Med J. 1970;2:237-8
Feldges DH, Barnes CG. Treatment of psoriatic arthropathy with either azathioprine or methotrexate. Rheumatol Rehab. 1974;13:120-4.
Du Vivier A, Munro DD, Verbow J. Treatment of psoriasis with azathioprine. Br Med J. 1974;1:49-51.
Maxavedan U, Tremaine WJ, Johnson T et al. Intravenous azathioprine in severe ulcerative colitis: a pilot study. Am J Gastroenterol. 2000;95:3463-68.
Benenson E, Fries JWU, Heilig B, Pollok M. High-dose azathioprine pulse therapy as a new treatment option in patients with active Wegener’s granulomatosis and lupus nephritis refractory or intolerant to cyclophosphamide. Clin Rheumatol. 2005;24:251-7.
Aries PM, Hellmich B, Reinhold-Keller E, Gross WL. High-dose intravenous azathioprine pulse treatment in refractory Wegener’s granulomatosis. Rheumatol. 2004;43:1307-8.
Sandborn WJ, Van Os EC, Zins BJ et al. An intravenous loading dose of azathioprine decreases the time to response in patients with Crohn’s disease. Gastroenterol. 1995;109:1808-17.
Gupta R. Prolonged remission of pemphigus induced by dexamethasone- cyclophosphamide pulse therapy. Indian J Dermatol Venereol Leprol. 2007;73:121-3.
Pasrich JS, Gupta R. Pulse therapy with dexamethasone cyclophospamide in pemphigus. Indian J Dermatol Venereol Leprol. 1984;50:199-203.
Pasricha JS, Thanzama J, Khan UK. Intermittent high-dose dexamethasone-cyclophosphamide therapy for pemphigus. Br J Dermatol. 1988;119:73-7.
Gupta R. Psoriasis: Response to azathioprine pulse therapy. 36th National Conference of Indian Association of Dermatologists, Venereologists and Leprologists; Chandigarh, India (abstract book). 2008. IL-51.
Ortonne JP. Recent developments in the understanding of the pathogenesis of psoriasis. Br J Dermatol. 1999;140:1-7.
Nickoloff BJ, Nestle FO. Recent insights into the immune-pathogenesis of psoriasis provide new therapeutic opportunities. J Clin Invest. 2004;113:1664-75.
Das RP, Jain AK, Ramesh V. Current concepts in the pathogenesis of psoriasis. Indian J Dermatol. 2009;54:7-12.
Halverstam CP, Lebwohl M. Nonstandard and off-label therapies for psoriasis. Clin Dermatol. 2008;26:546-53.
Lee CTJ, Gladman DD, Schentag CT, Cook RJ. The long-term use of azathioprine in patients with psoriatic arthritis. J Clin Rheumatol. 2001;7:160-5.
