Methylprednisolone pulse therapy

Preparation
Methylprednisolone pulse therapy
- a physical examination,
- the laboratory works up
Methylprednisolone (20–30 mg/ kg/day) Another course of pulse therapy
- chest X-ray, EKG
(max 1 g for 4 consecutive days) every month (1-6 session)
- bone mass densitometry
+ 200 ml of 5% dextrose IV slowly 2–3 hr.

- New lesions ceased to form recalcitrant or new lesions

- Established lesions began to heal

Oral Prednison (0.5mg/kg/day) +

Azathioprine (1-1.5 mg/kg/day)

Complete remission:
-absence of new lesion
-healing of established lesions by 80%

Oral Prednison trapered

(20-30mg/day)
+ Adjuvant

Follow up monthly

Complete remission Relapse

Oral Prednison trapered

>20 mg: 5 mg/mo
<20 mg: 2,5 mg/mo
+ Adjuvant

Complete remission Relapse

Oral Prednison total daily dose of 5 mg Adjuvant dosage increased

+ Adjuvant trapered + Oral Prednison total daily
½ last dosage/ mo until 2 months. dose of 5 mg

Oral Prednison total daily dose of 5 mg Complete remission Relapse

Follow up 1 year

No lesion + IF (-) + titer/serum Dsg normal Stop therapy

Operational Framework

Variable:
Medical Records sex, age, the duration
January 2006 -January 2016 disease onset - clinical
diagnosis, localization of the
lesions, the percentage of
body surface involvement,
biopsy-proven PV
medications, treatment
immunofluorescence (skin
efficacy, side effects, and
or mucosal surfaces)
recurrence.

Shohada-e-Tajrish Hospital Loghman-Hakim hospital

184 patient 128 patient

Exclution: 312 patient PV

Age< 18 and > 80 years,
pregnancy and lactation,
hypersensitivity to the
steroid preparation,
systemic infections, sepsis,
uncontrolled hypertension
or severe uncontrolled
diabetes mellitus,
moderate-to-severe heart
failure, and arrhythmia
Complete examination
Pulse therapy protocol
Monitoring
- physical examination
- the laboratory works up
- chest X-ray
- electrocardiogram (EKG)
- bone mass densitometry

Maintenance Therapy

Evaluation follow up
Conceptual Framework

Pemphigus Vulgaris
Ig G against Dsg-1 & Dsg-3
Skin & mucosal
Chronic blistering disorder
Loss of cell adhesion Flaccid bullae

biopsy-proven PV Painful erosions

Acantholysis
immunofluorescence

Treatment for PV : systemic steroids

High dose of oral prednisolone Intravenous pulse therapy

- Most side effect - Reduce side effect

- Long life therapy - Need feature study