Sulfasalazine and Pentoxifylline: Potential for Adjunctive Treatment of Pemphigus Vulgaris

Evidence shows that tumor necrosis factor α (TNF-α) contributes to acantholysis in pemphigus, and several reports document the efficacy of the TNF inhibitors infliximab and etanercept in autoimmune blistering disease. Sulfasalazine and pentoxifylline both inhibit TNF-α, although by different mechanisms: Pentoxifylline reduces its production, whereas sulfasalazine inhibits TNF-α mRNA levels and binds to circulating TNF-α. In this study, researchers examined sulfasalazine plus pentoxifylline as adjuvant treatment for pemphigus vulgaris in a placebo-controlled trial. Forty-two patients with moderate-to-severe pemphigus vulgaris received a combination of systemic steroids, cyclophosphamide, and both sulfasalazine and pentoxifylline, and 22 pati…