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Corticosteroids remain a standard primary therapy for patients with pemphigus vulgaris and pemphigus foliaceus. However, the dose of corticosteroids needed to control the disease frequently results in steroid-related toxicity. Most authorities advocate adding a steroid-sparing agent early in the course of the disease, but there is little consensus on which agent to use. Two studies address this controversy.
Investigators in Tehran assigned 120 new patients with pemphigus vulgaris to one of four treatment regimens (30 patients each):
2 mg/kg/day of prednisolone alone
Prednisolone plus 2.5 mg/kg/day of azathioprine for 2 months (then 50 mg/day for the rest of the study period)
Prednisolone plus 2 g/day of mycophenolate mofetil
Prednisolone plus 10…