Methotrexate Appears to Be a Steroid-Sparing Agent for Patients with Pemphigus

The initial treatment of patients with pemphigus is systemic corticosteroids, but the necessary dosage is associated with high risk for toxic effects. Therefore, most physicians treating pemphigus patients add a second “steroid-sparing” agent. There is no consensus on which agent is best, but most often, the choice is azathioprine or mycophenolate mofetil. Recently, some have suggested that rituximab might avoid the need for corticosteroids, but it probably wouldn't be a cost-effective primary choice. Methotrexate is familiar to most practicing dermatologists, and if effective as a steroid-sparing agent, might be considered among the second-line therapies.

These authors retrospectively analyzed the courses of 23 oral corticosteroid recipient…