Efficacy of intravenous immunoglobulin therapy in the treatment of refractory pemphigus vulgaris

Abstract

Objective To evaluate the efficacy of intravenous immunoglobulin (IVIg) in the treatment of refractory pemphigus vulgaris (PV). Methods This study included 12 patients who were diagnosed as active PV by clinical and pathological examination as well as direct and indirect immunofluorescent test. All patients had been treated with high dose of steroids for one month but little improvement was achieved. Besides prednisone, patients were given IVIg 400 mg/kg once a day for 5 consecutive days with a 23-day interval as a treatment course during which the application of azathioprim or cyclophosphamide was stopped. The serum levels of antibodies to desmoglein 3 were detected by ELISA kits. The effects of IVIg were evaluated by the response of patients and required doses of prednisone. Side effects were also evaluated in these patients.Results Remission was achieved in 10 (83%) of the 12 patients one week after the treatment wtih IVIg. The dosage of prednisone declined by 30% 4 weeks later. Severe side effects were observed in none but 1 patient,who developed headache, flushing and tachycardia 30 minutes after the intravenous injection of immunoglobulin, whereas all symptoms were relieved after modulation of injection speed. Following the treatment, serum levels of antibodies to desmoglein 3 were rapidly decreased by 54% in week 1, 70% in week 2,78% in week 3, while the level of IgG remained unchanged. Conclusions Mg treatment combined with prednisone could rapidly control severe PV resistant to conventional therapies. Therefore, it may serve as an adjuvant treatment of PV. Key words: Pemphigus; Infusions, intravenous; Immunoglobulins