Dexamethasone-cyclophosphamide Pulse Research Articles

A Case of Recurrent Pemphigus Foliaceus Following Noncompliance to Medication.

Pemphigus foliaceus (PF) is a rare autoimmune blistering disorder requiring consistent immunosuppressive therapy for management. A 66-year-old male with a history of PF presented with worsening blisters and erosions after discontinuing medication. The patient had flaccid bullae and erosions on the face, scalp, chest, and back. Histopathology confirmed PF. Treatment with oral prednisolone, azathioprine, and reinitiation of dexamethasone-cyclophosphamide pulse (DCP) therapy led to disease remission. This case underscores the importance of adherence to immunosuppressive therapy in PF management. It also highlights the role of affordable treatment regimens in ensuring patient compliance and successful outcomes.

Comparison of the Clinical Efficacy of Rituximab Infusion and Dexamethasone-Cyclophosphamide Pulse Therapy and Their Effect on Serum Th1, Th2, and Th17 Cytokines in Pemphigus Vulgaris–A Prospective, Nonrandomized, Comparative Pilot Study

Abstract Background: Rituximab infusion and dexamethasone-cyclophosphamide pulse (DCP) are the two most popular regimens used in pemphigus vulgaris (PV) in India. Objective: The present study compared the clinical efficacy of rituximab and DCP in Indian PV patients and their effects on serum Th1,2, and 17 cytokine levels. Materials and Methods: A total of 37 patients received DCP (Group A, n = 22) or rituximab (Group B, rheumatoid arthritis protocol (n = 15)) as per patients’ preference. They were monitored for clinical response, adverse events (AEs), changes in serum anti-desmoglein-1,3 antibody titers and Th1,2 and 17 cytokine levels at baseline and weeks 20 and 52. Results: The proportion of patients attaining disease control, remission, and relapse in groups A and B were 82% and 93%; 73% and 93%; and 27% and 50%, respectively, after a median duration of 2 months each for disease control; 4 and 4.5 months for remission; and 5 and 7 months for relapse post remission. The musculoskeletal AEs were the highest in the two groups. Significant and comparable decreases in anti-dsg1 and 3 titers from baseline to weeks 20 and 52 were observed in both groups. Th1 and Th17 cytokine levels decreased, while Th2 cytokines increased post-treatment in both groups. However, no correlation was found between change in body surface area of involvement by PV and anti-dsg titers and cytokine levels before and after therapy in both groups. Conclusion: Comparable clinical efficacy between DCP and rituximab was observed.

Dexamethasone-cyclophosphamide pulse therapy outcomes comparing pemphigus vulgaris and pemphigus foliaceus groups in a Brazilian cohort study

BackgroundDexamethasone-cyclophosphamide pulse (DCP) and dexamethasone pulse (DP) have been successfully used to treat pemphigus, but DCP/DP outcomes comparing pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are scarce. ObjectiveTo compare DCP/DP outcomes in a Brazilian cohort of PV and PF patients according to demographic and clinical data. MethodsRetrospective analytical cohort study, reviewing medical charts of PV and PF patients (for DCP/DP Phases I‒IV consult Pasricha et al.16‒18). Results37 PV and 41 PF patients non responsive to usual treatments were included similarly for DCP or DP therapy. Disease duration was longer among PF before DCP/DP prescription (p < 0.001); PF required a higher number of monthly pulses to acquire remission in Phase I (median 10 and 6 pulses, respectively; p = 0.005). DCP/DP outcomes were similar in both groups: remission in 37.8% of PV and 34.1% of PF after completed DCP/DP cycles following a median of 13 months (1–56 months follow-up); failure occurred in 13.5% of PV and 14.6% of PF in Phase I; relapse in 13.5% of PV and 12.2% of PF, and dropout in 27% of PV and 24.4% of PF in Phases II to IV. Mild side effects were documented. Study limitationsThe severity of PV and PF disease was not assessed by score indexes. ConclusionsPV and PF patients presented similar DCP/DP outcomes. DCP/DP should be initiated earlier in PF patients due to the longer duration of their disease in order to decrease the number of pulses and the duration of Phase I to acquire remission.

Clinicoimmunologic pattern, therapeutic response, and outcomes in connective tissue disease patients receiving steroid pulse therapy

Objectives: The aim of the study was to examine the clinicoimmunologic pattern, therapeutic response, and long-term outcomes in connective tissue disease (CTD) patients who received steroid pulse therapy. Material and Methods: Patients diagnosed with CTD (including diffuse cutaneous systemic sclerosis [dcSS], systemic lupus erythematosus [SLE], subacute cutaneous lupus erythematosus [SCLE], mixed CTD [MCTD], or overlap syndrome) who received steroid pulse therapy (period July 2017–June 2019) were identified in the hospital database and their relevant data were retrieved. Patients were followed up in June 2020 and response to treatment was evaluated by a self-devised patient-reported assessment scale. Results: Among the CTDs (n = 22; M: F = 1:6.3. Mean age = 39.95 ± 11.2 years), dcSS (45.5%) was the most common CTD seen followed by SLE (31.8%), MCTD (9.1%), SCLE (9.1%), and overlap syndrome (4.5%). CTD patients most commonly presented with joint pains (77.2%) or Raynaud’s phenomenon (77.2%). Antinuclear antibody (ANA) was positive in all patients. Fourteen patients received methylprednisolone; seven dexamethasone pulse, and one received dexamethasone-cyclophosphamide pulse. Only 10 patients could be followed up (mean duration of follow-up = 12.8 ± 6.4 months); two had complete remission, that is, clear; two had considerable benefit. Two did not tolerate pulse therapy and two died. Conclusion: Pulsed steroids can be a well-tolerated therapeutic modality with some benefit in CTD patients presenting to a dermatologist.

The Demographic Attributes, Clinical Features, and Optimal Management of 143 Patients with Pemphigus: A Retrospective Observational Study from a Tertiary Care Center of India.

Background:This retrospective study was to understand the clinico-epidemiologic and therapeutic aspects of pemphigus patients attending our clinic.Methods:We analyzed charts of 143 (M: F; 51:92) pemphigus patients having variable severity recorded between 2009 and 2019. Therapies were customized based on patient's age, disease severity, comorbidities, compliance prospects, and affordability. The patients were monitored monthly and as needed for therapeutic outcome in terms of disease control, reduced hospitalization, remission/relapse, and drug toxicity.Results:These patients were aged 15 to 86 years, the majority, 68 (47.5%), was 41 to 60 years of age. The pemphigus vulgaris in 83.9% patients was the commonest variant. Treatment regimens were; dexamethasone-cyclophosphamide-pulse (DCP) therapy in 51.2%, dexamethasone-azathioprine-pulse (DAP) therapy in 11%, dexamethasone-pulse (DP) therapy in 5.5%, rituximab in 24.4%, IVIg in 5.5% patients, and oral corticosteroids with or without adjuvant. Remission occurred after 2–17 (mean 5.8) DCP doses; 14 and 7 patients achieved remission for ≥2 y and ≥5 y, respectively. Rituximab was effective to treat both new and relapsed cases (n = 31). Additional treatment with another adjuvant prolonged remission in seven patients relapsed 12–16 months after treatment with rituximab alone. Overall, oral corticosteroids alone and DAP therapy showed unsatisfactory response. Adverse effects seen in 41.9% of patients were mainly corticosteroids related.Conclusion:The overall clinico-epidemiologic spectrum of pemphigus and therapeutic efficacy of DCP, DAP, or corticosteroids in this study was in sync with the literature. Combining rituximab and corticosteroids plus an immunomodulator initially (phase-1), followed by immunomodulator alone for one year (phase-2) will improve long-term (phase-3) therapeutic outcome. IVIg was effectively useful in patients with concurrent infections.

A Comparative Study to Evaluate the Efficacy and Cost of Rituximab versus Dexamethasone Cyclophosphamide Pulse in Patients of Pemphigus Vulgaris.

Introduction:Rituximab is slowly getting recognized as a promising steroid-sparing agent in the treatment of moderate to severe cases of pemphigus vulgaris (PV). We evaluated and compared the effectiveness, safety, and cost of therapy of rituximab versus dexamethasone cyclophosphamide pulse (DCP) in Indian patients with PV.Materials and Methods:It is a retrospective data analysis, from the Immunobullous disease clinic in a tertiary centre of eastern India, of management of PV. In our institute we use either rituximab or DCP for the management of moderate to severe cases of PV, depending on that we retrospectively divided the treated cases of PV in two groups. Patients who were treated with rheumatoid arthritis (RA) protocol of rituximab were considered to be group 1. Patients who were treated with DCP were included in group 2. Response was assessed by pemphigus area, and activity score (PAAS), Dermatology life quality index (DLQI); photographic documentation, and blood parameters were monitored.Results:Both groups showed significant improvement in PAAS and DLQI, the improvement was faster and well sustained in the rituximab group. In terms of safety and development of new vesicles, rituximab had a better profile with only 1 patient having adverse effects and none with new vesicles as compared to DCP (3 had adverse effects and 2 developed new vesicles).Conclusions:Rituximab offers the advantage of early and prolonged remission, lesser adverse effects, better effectiveness, less risk of relapses, faster improvement of PAAS, and DLQI. Though rituximab is an expensive drug, but on evaluating the cost of whole therapy, it was seen that rituximab infusions are actually cheaper compared to DCP pulse. We suggest, rituximab can be used as the first-line of therapy for pemphigus vulgaris in the Indian context.

A study on the outcome of pulse therapy in vesicobullous disorders at a tertiary care centre in Chidambaram, Tamilnadu

Introduction: With the advent of pulse therapy and adjuvant immunosuppressive drugs, the outcome and prognosis of vesicobullous disorders have been improved to a greater extent. Different regimen protocol has been tried and this descriptive study was carried out to assess the outcome of various pulse therapy regimens in vesicobullous disorder at our centre. Methods: A total of 26 vesicobullous patients were enrolled for the study. Diagnosis was made clinically and confirmed by histopathology. They received treatment with Dexamethasone-Cyclophosphamide pulse (DCP) or Dexamethasone -Azathioprine pulse (DAP) or Dexamethasone pulse (DP) therapy and were followed up for clinical remission and side effects of therapy. Results: There was a total of 26 patients comprising 69.23% females and 30.77% males and 50% were between the age group of 40-50 years. Pemphigus vulgaris was the commonest clinical type seen in 69.23%.DCP was given for 22(84.62%) patients, dexamethasone pulse in 3(11.54%) and DAP in one (3.85%). In DCP group 77.27% of patients were in Phase I and 22.73% achieved clinical remission. One patient was refractory to DCP and required rituximab infusion. Weakness, headache, vomiting and weight gain were the commonest side effects encountered in our study. Avascular necrosis of femur and reactivation of pulmonary tuberculosis were the major side effects noticed in one patient each. Conclusion: DCP therapy prove to be an excellent therapeutic regimen in case of vesicobullous disorders to attain faster recovery sparing the adverse effect of corticosteroids. DAP can be an useful therapeutic option in patients who were unmarried or in reproductive age group. Keywords: Pemphigus vulgaris, Dexamethasone-cyclophosphamide pulse. Dexamethasone-azathioprine pulse, Dexamethasone pulse

Comparative retrospective evaluation of efficacy of rituximab therapy with dexamethasone cyclophosphamide pulse therapy in patients of pemphigus vulgaris at a tertiary care hospital

Background: Popular treatment modalities for pemphigus vulgaris are dexamethasone cyclophosphamide pulse (DCP) therapy and rituximab. However, no previous studies are available which have compared the efficacy of the two modalities. Aim: This study aims to study the response of pemphigus vulgaris to DCP and rituximab therapy and to compare the efficacy and safety of the two modalities over a period of 1½ years. Materials and Methods: This was an observational retrospective study. The medical records of a total of 14 pemphigus vulgaris patients from July 2016 to July 2018 were retrieved for analysis who were treated with either DCP therapy or rituximab (7 in each group). Patients treated with any other modality except DCP/rituximab were excluded from the study. The pemphigus disease area index (PDAI) scores at baseline, 1 month, 6 months, 12 months, and 18 months were analyzed using statistical software (Stata Corp. 2013. Stata Statistical Software: Release 13. College Station, TX, Stata Corp. LP, Texas, USA). Outcome Measures: Time to achieve the end of consolidation phase, improvement in PDAI scores, adverse effects, and relapse. Results: Rituximab group achieved early remission; however, there was no statistically significant difference in the two groups in the time when they reached the end of consolidation phase. Repeated measure anova showed significant difference in PDAI scores within the two groups over time. One patient in DCP group relapsed following discontinuation of cyclophosphamide due to complications. Overall, the scoring of disease severity was markedly reduced in both the groups. Conclusion: Both DCP therapy and rituximab were found to be extremely and equally effective in inducing and maintaining remission.

Psoriasis vulgaris developing in healed pemphigus vulgaris: A rare case of epitope spread or isotopic response?

Although psoriasis and autoimmune blistering diseases are considered to be disorders with completely different etiopathogenesis, literature has documented a few cases of psoriasis associated with bullous diseases, particularly bullous pemphigoid. Here, we report the case of a 30-year-old male presenting with multiple flaccid blisters and erosions, clinically and histopathologically consistent with the diagnosis of pemphigus vulgaris. Although all these lesions resolved after two doses of dexamethasone cyclophosphamide pulse therapy, he returned 3 weeks later with multiple erythematous scaly plaques developing over the postinflammatory areas, compatible with the diagnosis of psoriasis vulgaris, which necessitated a modification in the treatment protocol. This rare case highlights the diagnostic and therapeutic challenges accompanying this unique scenario and attempts to elucidate the probable pathogenic mechanisms underlying the co-existence (simultaneous or sequential) of these two apparently unrelated dermatoses.

Dexamethasone Cyclophosphamide Pulse Therapy in Immunobullous Diseases: Our Experience

Background: Dexamethasone cyclophosphamide (DC) pulse therapy seems to be emerging affordable modality of treatment in immunobullous disorders. The objective of this study was to describe the effectiveness of DC pulse therapy in immunobullous disease in our setting.&#x0D; Methods: This was a retrospective study carried out in the Department of Dermatology of a tertiary referral centre by reviewing the medical records of all the patients of immunobullous diseases receiving DC pulse therapy from January 2010 through January 2014.&#x0D; Results: There were a total of 10 patients of immunobullous disease receiving the therapy during above mentioned period (7- Pemphigus Vulgaris, 2- Pemhigus foliaceus, 1- Bullous Pemphigoid).There were 5 males and 5 females receiving the therapy, with the mean age of the diseased at presentation being 47.4 years. Out of 10 patients, 2 patients were lost to follow up after the 1st pulse. Out of 8 patients, 6 patients (75%) achieved clinical remission. The mean time to remission was 10.6months (Range: 3 months to 23 months). The major adverse effects seen during therapy were diabetes (50%) and leucopenia (20%).&#x0D; Conclusions: DC pulse therapy seems to be effective treatment modality in the management ofimmunobullous disorder in our setting with good safety profile.

Managing the challenging cases of pemphigus vulgaris with modified pulse therapy: case series

&lt;p class="abstract"&gt;In pemphigus vulgaris, pulse therapy is a promising modality to achieve better therapeutic response and to minimize the side effects of daily steroids. Here we report 5 different challenging situations where we successfully managed with modification of pulse therapy. Our first case had multiple comorbidities with persistent skin infections managed with dexamethasone and cyclophosphamide pulse (DCP) and interval pulse. The second case was unmarried hypertensive male with poor DLQI managed with Azathioprine pulse therapy. The third case was uncontrolled diabetic patient with pulmonary tuberculosis managed with rituximab. The fourth case was diabetic and hypertensive was managed with one day dexamethasone cyclophosphamide pulse therapy (DCP). The fifth case was not completed family with cushingoid features managed with dexamethasone azathioprine pulse therapy (DAP). Pulse therapy is effective in controlling disease activity in pemphigus. But it can be modified in some situations according to the patient needs.&lt;/p&gt;

Modifications of pulse therapy in pemphigus: a retrospective study of 72 patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pulse therapy defines as the administration of supra-pharmacologic doses of drugs in an intermittent manner to enhance the therapeutic effects and reduce the side effects. Dexamethasone-Cyclophosphamide pulse (DCP) therapy is known since 1986 but there are certain limitations due to side effects of cyclophosphamide.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study was carried out where 72 patients of pemphigus were treated with modified pulse therapy like DCP, DAP, DMP from 2006-2016. Modifications were made in DCP therapy protocol and substitution of cyclophosphamide with either azathioprine or methotrexate in few patients.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Male to female ratio observed was 1:0.7. Majority of them belonged to age group of 31-40 years (41.66%) followed by 41-50 years (33.3%). Maximum number of patients had pemphigus vulgaris (86.1%) followed by pemphigus foliaceous (12.5%) and IgA pemphigus (1.38%). Good response was observed in patients who took pulse therapy regularly.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Modifications to the original DCP therapy protocol were found to be very effective, useful and it shortened the duration of phase I. Side effects were minimal and manageable.&lt;/p&gt;

Prospective Study of Pulse Therapy in Childhood Pemphigus Disorders.

Background:Pemphigus disorders are a group of immunobullous diseases affecting skin and/or mucus membranes. Dexamethasone cyclophosphamide pulse (DCP)/dexamethasone only pulse (DOP) therapy has shown promising results in the management of pemphigus group of diseases in adults.Aim:To evaluate the outcome of pulse therapy (PT) in pediatric cases diagnosed with pemphigus vulgaris (PV).Materials and Methods:Prospective study of 12 pediatric cases of PV from 2010 to 2015 and treated with PT in Gandhi Hospital. The patients were treated with DOP therapy, with a dose of 50 mg of dexamethasone in 250 ml of 5% dextrose in pediatric patients below the age of 12 years and 100 mg of dexamethasone in 500 ml of 5% dextrose for above 12 years, for three consecutive days. No interpulse steroids or rituximab were given to any patients in our study.Results:Out of 12 cases, 10 were female and 2 were male children. Four cases were below the age of 12 years and 8 cases were above the age of 12 years. The lowest age was 11 years female and highest age was 16 years male child. Average duration of illness is between 4 and 6 months. Six cases completed three phases, four cases were in phase II cycle 7, and two cases were in phase IV. In majority of cases clinical improvement was observed between 2 and 4 pulses in phase I. No significant adverse effects were observed in any case except in two cases who developed headache, shivering, and nausea in first one to two pulses of phase I and managed conservatively.Conclusion:Our study shows that PT gives good response in the management of pemphigus in children, in terms of remission and side effects. There was no significant major adverse effect as observed in adults. In low-resource centers such as government institution, PT would be one option. Further studies and long-term follow-up are required to weigh the risks and benefits of PT in pediatric age group.

Pemphigus foliaceus: Clinicoepidemiological study at tertiary care center

Background: Pemphigus foliaceus (PF) is characterized by shallow erosions with erythema, scaling, and crusting over seborrheic areas of the face, scalp, and chest with characteristic histopathology and direct immunofluorescence (DIF). Aim: To study the clinicoepidemiological profile of patients with PF and response to treatment, especially pulse therapy. Materials and Methods: This was a prospective clinical and therapeutic study of 20 patients WITH PF, attending DVL Department, from May 2007 to April 2016. The diagnosis was made based on clinical features, histopathology, and DIF. Clinical variants of PF were studied, and severity was assessed based on body surface area involvement. After detailed evaluation, 18 patients started on pulse therapy [13 dexamethasone cyclophosphamide pulse (DCP), 3 dexamethasone azathioprine pulse (DAP), 2 dexamethasone-only pulse (DOP)]. Two patients were not started on pulse therapy for medical reasons. Results: The most common age group affected was 51–60 years. Male: female ratio was 1:1. Clinical variants observed were classical localized – 4, classical generalized – 10, erythrodermic – 4, pemphigus erythematosus – 1, and acral vesiculopustular lesions – 1. Nail changes and small erosion on the inner aspect of the lower lip were present in two patients each. The average time to remission was 7.3 months. Of 18 patients, 14 patients responded well to DCP/DAP/DOP therapy. Two patients lost to follow-up in phase 1. Two patients had frequent relapses and started on methotrexate; the disease is under control in one patient. Conclusion: PF usually localized to seborrheic areas; in our study, generalized papulosquamous lesions and erythroderma-like presentation were predominant. The majority of the patients showed remission with pulse therapy, and two patients require addition of immunosuppressants in the follow-up period.

Outcome of pulse therapy in pemphigus: A 10-year study

Background: Pemphigus is a potentially fatal autoimmune blistering disease affecting the skin and mucosa. Pulse therapy has been tried in pemphigus in India and other countries with variable results. Aims: The aim of the study was to assess the outcome of pulse therapy in pemphigus patients treated over a period of 10 years. Materials and Methods: Patients with pemphigus treated with pulse therapy from 2006 to 2016 were taken into the study. Results: A total of 122 pemphigus patients were included in the study, of which pemphigus vulgaris was diagnosed in 112 patients, pemphigus foliaceus in 9 patients, and pemphigus vegetans in 1 patient. The mean age was 37.75 ± 8.60 years, with an age range of 19–58 years. Duration of the disease ranged from 7 days to 3 years, with a mean of 6.87 ± 8.81 months. Ninety-three patients were started on dexamethasone cyclophosphamide pulse therapy and 29 on dexamethasone azathioprine pulse therapy. Thirty-three patients discontinued treatment, pulse therapy was stopped in two patients due to complications, and four patients died while on treatment. Out of the remaining 83 patients, 22 patients were in Phase I, 13 in Phase II, 7 in Phase III, and 41 in Phase IV by the end of the study. Sixty-one patients completed Phase I and were maintaining remission. Seven patients relapsed (3 in Phase II and 2 each in Phase III and IV). Ten patients completed 5 years of Phase IV and were considered cured of the disease. Generalized weakness, myalgia, headache, diabetes, and amenorrhea were the most common side effects. Conclusion: Pulse therapy was found to be effective in inducing and maintaining remission in the treatment of pemphigus. Prevention of relapses requires continuation of the treatment during Phase II and III.

Rituximab: A Magic Bullet for Pemphigus.

Pemphigus, an autoimmune disease, was fatal before the era of corticosteroids. With the advent of steroids, mortality decreased but morbidity was present due to the side effects of high dose steroids. Newer drugs targeted at the molecular level are said to have fewer side effects and improved effectiveness. The aim of our study was to assess the effectiveness of one such drug, Rituximab, a biological, in treating pemphigus vulgaris and to identify common adverse events. It was an open label prospective interventional study, conducted from September 2013 to May 2015, in the Department of Dermatology, Stanley Medical College, Chennai, Tamil Nadu, India. Twenty patients with pemphigus were included in the study. Ten were refractory to conventional therapy and 10, new cases. Patients who satisfied inclusion and exclusion criteria were included in the study after informed, written consent. Rituximab was administered according to Rheumatoid arthritis protocol. The patients were followed up as out patients after discharge, end points and adverse events were noted. There were 14 females (70%) and six males (30%). The mean age of the study group was 41.35 years. The mean disease duration was 11.7 months. The mean duration of follow up being 14.25 months. After rituximab, 13 patients remained in remission for varying periods of 3-22 months. The mean duration of complete remission off- treatment with Dexamethasone Cyclophosphamide Pulse (DCP) was 3.6 months; with rituximab it was 8.8 months. Seven (35%) patients relapsed during the study of whom six had received rituximab after being refractory to conventional treatment. Patients who relapsed had higher mean disease duration (21 months) than the remission group (6.384 months). Two patients (10%) developed immediate adverse events. Six patients (30%) developed late adverse events the commonest being reactivation of herpes labialis. Rituximab was effective in treating pemphigus vulgaris, was significantly better than conventional treatment, decreased the need for additional steroids and other immunosuppressants and induced prolonged remission. Rituximab was more effective when given early in the disease process. Further studies may highlight the need for additional cycles of rituximab to maintain sustained remission.

Study of dexamethasone cyclophosphamide pulse therapy in systemic lupus erythematosus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Systemic lupus erythematosus (SLE) is always a challenge to the treating dermatologists. Pulse therapy is the use of supra pharmacological doses of drugs to achieve a desired therapeutic effect. The success of dexamethasone cyclophosphamide pulse therapy (DCP) in autoimmune bullous diseases has prompted dermatologists to use DCP in SLE but very few studies are available which objectively measure the outcome of DCP therapy in SLE. The aim of our study is to study the efficacy of dexamethasone cyclophosphamide pulse in patients with SLE and to use objective scoring systems to assess efficacy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 20 SLE patients who satisfied the inclusion criteria were administered intravenous dexamethasone 100 mg over three days with cyclophosphamide 500 mg on day1, followed by oral cyclophosphamide 50 mg daily. In patients whom cyclophosphamide cannot be used oral azathioprine was given. Response to treatment was assessed using CLASI (cutaneous lupus area severity index), clinical evaluation of dermatological and systemic symptoms and laboratory parameters such as ANA, Anti dsDNA, ESR etc.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the patients showed clinical improvement with statistically significant fall in CLASI scores and anti dsDNA values. The mean duration of pulses required to achieve remission was 9 pulses. No major adverse effects were observed in any of the patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Dexamethasone cyclophosphamide pulse therapy is an effective and safe option in the management of patients with SLE.&lt;/p&gt;

Study of Dexamethasone-Cyclophosphamide Pulse Therapy in Systemic Lupus Erythematosus in a Tertiary Care Center in Chhattisgarh

Study of Dexamethasone-Cyclophosphamide Pulse Therapy in Systemic Lupus Erythematosus in a Tertiary Care Center in Chhattisgarh

Generalized Morphea following Radiotherapy for an Intracranial Tumor.

Morphea is a localized scleroderma variety which can be circumscribed or generalized and is characterized by sclerotic plaques developing on trunk and limbs. Surgery and radiation have been implicated as etiological factors for the development of morphea. Majority of the radiation-induced morphea cases have occurred in patients with breast cancer. The affected areas have been generally restricted to the area of radiation and nearby surrounding area in most of the reported cases. We hereby report a case of a 27-year-old male who developed radiation-induced progressive generalized morphea after getting radiotherapy for an intracranial tumor. His condition improved after dexamethasone-cyclophosphamide pulse therapy. With increased incidence of cancer worldwide and radiotherapy as a modality of treatment, it is imperative to follow the patient and look for the development of morphea which itself is a debilitating disease.

Efficacy and Safety of Dexamethasone Cyclophosphamide Pulse Therapy in the Treatment of Pemphigus - An Open Randomized Controlled Study

Abstract Background Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination. Methods Patients were allocated into two treatment groups. Group A received treatment with DCP pulse regimen while group B was treated with oral corticosteroids and cyclophosphamide lasting for 4 years. Results 18 out of 20 patients in DCP group entered into remission, 1–29 months after complete stoppage of treatment. The two patients relapsed, one in phase III and another in phase IV of DCP. Both were reverted back to phase I and again treated with IV phase regimen of DCP. All the 20 patients in oral corticosteroids and cyclophosphamide group developed repeated relapses (4–6 times) during the study period. Conclusion This study shows that DCP therapy can put pemphigus into prolonged/permanent remission as compared to corticosteroid-cyclophosphamide group where relapses are frequent. Lately, some dermatologists have questioned the efficacy of DCP in treating pemphigus. However, this could be due to usage of wrong combination of drugs or short study duration.