Oral glucocorticoid pulse therapy for induction of treatment of canine pemphigus foliaceus – a comparative study

Abstract

The management of canine pemphigus foliaceus (PF) often requires long-term immunosuppressive treatment that is often associated with unacceptable adverse effects. High-dose glucocorticoid pulse therapy, an alternative protocole used for pemphigus in people, has been shown to provide rapid improvement in dogs with pemphigus foliaceus and vulgaris. To further identify the benefit of pulse therapy for management of canine PF, we compared the outcomes of oral glucocorticoid pulse and traditional therapies during the first 3 months of disease management. Dogs were allocated based on their oral glucocorticoid regimen during the first 12 weeks of PF management into the 'traditional' (20 dogs) or the 'pulse' (18 dogs) treatment groups. The proportion of dogs achieving complete remission (CR) during the first 12 weeks of treatment was significantly higher for the 'pulse' (61%) than for the 'traditional' group (15%; P = 0.0063). The maximal oral glucocorticoid dosage given to dogs from the 'traditional' group was significantly higher (median: 3.2 mg/kg) than that given between pulses to dogs from the other group (median: 1.1 mg/kg; P < 0.0001). There was no significant difference between groups in the time needed to achieve CR, the proportion of dogs requiring adjuvant immunosuppressive treatment or in the proportion of dogs experiencing severe adverse drug reactions. These results suggest several benefits associated with oral glucocorticoid pulse therapy, such as a higher proportion of dogs achieving CR during the first 3 months, a lower average maximal oral glucocorticoid dosage given between pulses and minimal adverse drug events.