Prolonged remission of psoriasis with azathioprine pulse therapy

Abstract

BackgroundVarious therapies used for the treatment of psoriasis though are able to produce remission but relapses remain the common problem. Treatment with Azathioprine Pulse Therapy (intermittent high dose (IHD) and continuous low dose (CLD) azathioprine) can produce prolonged and durable remission in psoriasis was observed. MethodsSixty patients with psoriasis were treated with monthly IHD azathioprine (500 mg on 3 consecutive days), CLD azathioprine (100 mg orally) was given daily in between IHD. The entire treatment schedule was divided into four phases. During phase I, treatment with IHD and CLD azathioprine was continued till complete clearance of lesions, when patients proceeded to phase II while continuing treatment with IHD and CLD. After continued remission for a period of 9 months, treatment with IHD was stopped, but CLD was continued (Phase III). After 9 months of phase III treatment, CLD was also withdrawn, and patients were followed-up without any treatment (Phase IV). ResultsForty five patients completed treatment and are in remission without any treatment. ConclusionsOut of 45 patients in phase IV, 25 patients are in continuous remission for more than 3 years (maximum 93 months), 9 are in remission for 1–3 years, while 11 are less than 1 year in continuous remission after all treatment was stopped. Thus azathioprine pulse therapy regimen produced prolonged remission in psoriasis.