The role of adjuvant therapy in pemphigus: A systematic review and meta-analysis.
BACKGROUND
The assumption that adjuvant modalities have added value to oral glucocorticoids in the treatment of pemphigus is intuitively sound but has not been conclusively proven.


OBJECTIVE
We sought to compare the efficacy and safety of oral glucocorticoid treatment with or without adjuvants for pemphigus vulgaris and pemphigus foliaceus.


METHODS
We performed a systematic review and meta-analysis of randomized controlled trials. The primary outcome was remission. Secondary outcomes were disease control, time to disease control, relapse, time to relapse, cumulative glucocorticoid dose, withdrawal because of adverse events, and all-cause death. Trials were pooled irrespective of adjuvant type evaluated.


RESULTS
Ten trials (559 participants) were included. Adjuvants evaluated were azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine, intravenous immunoglobulin, plasma exchange, and infliximab; not all were included in every analysis. Although adjuvants were not beneficial for achieving remission, they were found to collectively decrease the risk of relapse by 29% (relative risk 0.71, 95% confidence interval 0.53-0.95).


LIMITATIONS
Different adjuvants were pooled together.


CONCLUSION
Adjuvants have a role in pemphigus treatment, at least in reducing the risk of relapse. Further randomized controlled trials of other promising modalities are warranted.
['Atzmony|Lihi|L|', 'Hodak|Emmilia|E|', 'Leshem|Yael A|YA|', 'Rosenbaum|Omer|O|', 'Gdalevich|Michael|M|', 'Anhalt|Grant J|GJ|', 'Mimouni|Daniel|D|']
D000970:Antineoplastic Agents D004359:Drug Therapy, Combination D005260:Female D005500:Follow-Up Studies D005938:Glucocorticoids D006801:Humans D007166:Immunosuppressive Agents D008297:Male D010392:Pemphigus D016032:Randomized Controlled Trials as Topic D012008:Recurrence D012074:Remission Induction D018570:Risk Assessment D012380:Role D012720:Severity of Illness Index D016896:Treatment Outcome
adjuvant therapy pemphigus systematic review meta-analysis glucocorticoids pemphigus vulgaris