Immunologic prediction of relapse in patients with pemphigus vulgaris (PV) in clinical remission

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• 作者：Maryam Daneshpazhooh ; MD^a ; ^{daneshpj@tums.ac.ir" class="auth_mail" title="E-mail the corresponding author} ; Vahid Zafarmand Sedigh ; MD^a ; Kamran Balighi ; MD^a ; S. Hamed Hosseini ; MD^b ; Ali Ramezani ; MD^a ; Mohammad-Sadegh Kalantari ; MD^a ; Narges Ghandi ; MD^a ; Maryam Ghiasi ; MD^a ; Azita Nikoo ; MD^c ; Cheyda Chams-Davatchi ; MD^a
• 关键词：anti-desmoglein 1 ; anti-desmoglein 3 ; clinical remission ; direct immunofluorescence ; pemphigus vulgaris ; relapse ; relapse-free time
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：74
• 期：6
• 页码：1160-1165
• 全文大小：437 K

文摘

Pemphigus vulgaris (PV) is characterized by multiple relapses, occurring especially in patients on minimal therapy or off therapy.

2">Objective

To identify immunologic predictors (anti-desmoglein [Dsg] 1 and 3 antibodies; direct immunofluorescence [DIF]) for relapse in PV patients.

Methods

Eighty-nine patients in complete clinical remission for at least 6 months and receiving less than or equal to 10 mg prednisolone daily and no immunosuppressive drugs were evaluated using DIF (n=89) and Dsg ELISA (n=46). They were followed until relapse or for at least 18 months.

Results

20">DIF was positive in 44 of 89 patients (49.5%); anti-Dsg 3 antibodies were detected in 18 of 46 patients (39.1%) and anti-Dsg 1 antibodies were detected in 4 of 46 patients (8.7%). Relapse occurred in 38 patients (42.7%). Mean relapse-free time was significantly shorter in anti-Dsg 3-positive patients compared to anti-Dsg 3- negative patients (P = .015) and in DIF-positive patients compared to DIF-negative patients (P = .047), but not in anti-Dsg 1- positive patients compared to anti-Dsg 1-negative patients (P = .501). Sensitivity and predictive values of neither of these tests were high.

Limitations

25">Small number of anti-Dsg 1-positive patients and use of conventional ELISA.

Conclusion

Positive anti-Dsg 3 ELISA and, to a lesser degree, positive DIF are predictors of relapse in PV patients in clinical remission. Decision on discontinuing treatment should be based on the results of these tests as well as on clinical findings.