The Management of Pemphigus Patients: Clinical Remission, Discontinuation of Therapy and Our Experience

The goal of therapy in pemphigus patients is to control the disease with appropriate medication and to discontinue the treatment. The best indicator of the treatment efficiency is mortality and the lenght of clinical remission.Because of the lack of reliable criteria to evaluate the partial or complete and sustained remission seen in pemphigus patients,it is difficult to decide the withdrawal of their drugs. When pat?ents are in the active phase of the disease the main parameter for reducing the dose of drugs is clinical response When the patient is in clinical remission direct immunofluorescence test (DIF ),valuable in the management of the disease, is used. Since a negative DIF finding implies immunologic remision of the disease, therapy can be discontinued in patients with negative results of DIF after a long period of clinical remission. In our series, 88 patients with pemphigus were examined for clinical remission and immunological activity. The indirect imunofluorescence (IIF) was positive in 34 patients. 54 patients who were in clinical remission, 26 patients had negative and 28 patients had positive results of DIF. Patients with negative results of DIF had their medications discontinued while patients with positive results continued their therapy. During the follow up period, 6 of 26 patients with negative DIF relapsed.

Keywords: Pemphigus, direct immunofluorescence, ind?rect imunofluorescence, clinical remission

Pemfigus Hastalar?n?n Takibi: Klinik Remisyon, Tedavinin Sonland?r?lmas? ve Klinik Deneyimimiz

Pemfigus tedavisinde amaç erken tan? ve uygun ilaçlar ile uzun süreli remisyon sa?lamak ve tedaviyi kesebilmektir. Tedavi etkinli?inin en iyi göstergesi mortalite ve remisyon süresidir. Pemfiguslu hastalarda görülen k?smi veya tam ve uzun süreli remisyonu de?erlendiren belirli kriterlerin yoklu?u tedaviyi sonland?rmaya karar vermeyi zorla?t?rmaktad?r. Hastalar aktif dönemde iken doz azaltmada ana parametre olarak klinik yan?t kullan?l?rken, klinik remisyonda immünolojik durumu gösteren direkt immünfloresan test (DIF) kullan?l?r. Negatif DIF bulgusu immünolojik remisyonun göstergesi oldu?undan DIF testi negatif olan hastalarda hastalar uzun süre izlenmek üzere tedavi sonland?r?labilir. Klini?imizde takip edilen 88 pemfiguslu hasta klinik remisyon ve immünolojik aktivite aç?s?ndan de?erlendirildi?inde IIF’nin 34 hastada pozitif oldu?u görüldü. Klinik remisyondaki 54 hastan?n 26’s?nda DIF negatif, 28’inde pozitif bulundu. DIF sonucu negatif olan hastalar?n tedavisi kesilirken, pozitif olan hastalarda tedaviye devam edildi. DIF’i negatif olan 26 hastan?n 6’s?nda relaps görüldü.

Anahtar Kelimeler: Pemfigus, direkt immünfloresan, indirekt immünfloresan, klinik remisyon