Table 5.
Methotrexate
| Author/year | Type of study |
N
M/F |
Age range/mean (years) | Type of pemphigus vulgaris | Previous Rx | Duration of disease before MTX | MTX dose |
|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | |
| Lever and Goldberg et al. [69]/1969 | Case series |
N = 5 M/F = 4/1 |
26–79 | Mucocutaneous | Pred | 11 mo to 7 years | 25–150 mg/week |
| Jablonska et al. [70]/1970 | Case series | N = 10 | 32–83 (mean = 58.8) | NM | Pred, triamcinolone | NM | 25 mg/week |
| Piamphongsant and sivayathorn et al. [71]/1975 | Case series | N = 3 | 33–48 (Mean = 43.8) | NM | Pred, MTX in 1 pt | NM | 12.5–25 mg/week |
| Lever and Schaumburg-Lever, Lever et al. [72, 73]/1977 | Case series | N = 41 | 20–79 (mean = 51) | Mucocutaneous | None | NM | 20–50 mg/week |
| Mashkilleyson et al. [74]/1988 | Case series | N = 53 | 26–75 (mean = 56) | NM | Pred | NM | 25–50 mg/week |
| Smith and Bystryn et al. [75]/1999 | Case series | N = 9 M/F = 8/1 | Mean = 59 | NM | Pred | NM | 12.2 mg/week (13 courses) |
| Baum et al. [76]b/2012 | Retrospective study | N = 30 | NM | NM | NM | NM | 15 mg/week |
| Author/year | Duration to initial improvement in symptoms after MTX | Follow up period | Concomitant Rx | Outcome | Duration on medication (MTX)a | PV antibody titer changes after Rx | Adverse effects |
|---|---|---|---|---|---|---|---|
| 8 | 9 | 10 | 11 | 12 | 13 | 14 | |
| Lever and Goldberg et al. [69]/1969 | NM | 5–7 years | Pred | CR on = 4, improvement = 1. additional details NM | Pred d/c in 1 patientt at fifth year. Tapered in rest on clinical improvement. MTX continued In all patients at end of f/u |
IIF: Pt1—1:640 to 1:80 to 1:10 to neg Pt2—1:40 to 1:10 Pt3—1:40 to 1:10 Pt4—1:20 to 1:40 to 0 Pt5—1:80 to 1:40 to 0 to 1:10 |
Nausea, lassitude |
| Jablonska et al. [70]/1970 | 1–30 weeks | NM | Pred, triamcinolone | Improvement in 8/9 pts after 1–30 weeks of treatment. Death = 1 due to bronchopneumonia. Whether PR or CR—NM | Duration of MTX 1–7.5 mo. MTX discontinued in six patients due to its side effects | NM | Bronchopneumonia, cerebral thrombosis, septicemia, bronchitis, anemia, diarrhoea, leucopenia, bacterial infection |
| Piamphongsant and sivayathorn et al. [71]/1975 | NM | NM | Pred | Death = 1 due to Pred side effects; CR on = 2 | Duration of MTX 33–78 days maintenance dose contd at end of f/u | NM | NM |
| Lever and Schaumburg-Lever, Lever et al. [72, 73]/1977 | NM | 11–15 years | Prednisone = 40–360 mg/day | Death = 4 unrelated to MTX; CR on = 8, PR on = 15, CR off = 14 | MTX D/c in 14 pts with CR off therapy, mean duration of f/u after d/c of medication was mean 2.6 years (3 mo to 8 years) without any relapse. Rx contd in others at end of f/u | NM | Nausea, leucopenia, pyoderma |
| Mashkilleyson et al. [74]/1988 | 2–3 days | NM | Pred | Not effective in nine patients, CR on = 31; PR on = 11 | MTX discontinued in two patients due to its side effects | NM | Pneumonia, exacerbation of gastric ulcer, pyoderma, moniliasis, necrtotizing gingivitis, TB of larynx |
| Smith and Bystryn et al. [75]/1999 | NM | NM | Prednisone = 3–40 mg/day | CR on = 6 pts within 6 mo of start of therapy. Additional details NM | Pred d/c in 6 pts within 6 mo after start of MTX therapy. MTX continued in all as flare-ups were seen within 23 days of discontinuing MTX at end of f/u | NM | Nausea, mild elevations of transaminase |
| Baum et al. [76]b/2012 | NM | NM | Pred | Improvement in 21 pts at 6 mo of treatment. Additional details NM | Pred dose tapered | NM | Mild adverse effects |
Pred prednisone, MTX methotrexate, CR off complete remission off therapy, CR on complete remission on therapy, PR partial remission, PR on partial remission on therapy, PR off partial remission off therapy, R relapse, NR no response, F/U follow-up, d/c discontinue, mo months, d days, pt patient, NM not mentioned, IIF indirect immunofluorescence, Dsg1 and Dsg3 desmoglein 1 and 3
aDuration on medication included the time period on medication prior to the start of follow-up to this paper
bOnly abstract is available for Baum et al. [75]/2012