{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:37:18Z","timestamp":1761709038956},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,3,3]],"date-time":"2015-03-03T00:00:00Z","timestamp":1425340800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pemphigus vulgaris (<jats:styled-content style=\"fixed-case\">PV<\/jats:styled-content>) is a rare autoimmune blistering condition. Treatment typically combines corticosteroids with another immunosuppressive agent, such as azathioprine, mycophenolate mofetil (<jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content>) or rituximab.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study aims to compare these second agents for their clinical efficacy and steroid\u2010sparing effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010centre, retrospective observational cohort study of 21 patients with oral <jats:styled-content style=\"fixed-case\">PV<\/jats:styled-content> over a 6\u2010year period, 18 of whom were newly diagnosed. Of the latter, the first 13 were initially given azathioprine, progressing to <jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content> and then rituximab on treatment failure, while the next five patients started directly on <jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 13 newly diagnosed patients, 2\/13 were intolerant of azathioprine, and only 1\/11 was controlled, with a median time to treatment failure (<jats:styled-content style=\"fixed-case\">MTTF<\/jats:styled-content>) of 254 days. <jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content> was given to 17 patients, either <jats:italic>de novo<\/jats:italic> (5) or after azathioprine (12), and was significantly more effective, controlling activity in 4\/17 patients, and for a significantly longer time (<jats:styled-content style=\"fixed-case\">MTTF<\/jats:styled-content> 395 days, <jats:italic>P<\/jats:italic> = 0.019). All 13 patients failing <jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content> received rituximab, seven required a second dose, and three, a third dose. All patients responded, with 11\/13 able to cease steroids. Control was maintained for a similar time to <jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">MTTF<\/jats:styled-content> 364 days, <jats:italic>P<\/jats:italic> = NS). Rituximab also had the best steroid\u2010sparing effect followed by <jats:styled-content style=\"fixed-case\">MMF<\/jats:styled-content>, then azathioprine. Side\u2010effects were common with azathioprine, while the other two agents were well tolerated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Rituximab was the most effective of the three immunosuppressives for <jats:styled-content style=\"fixed-case\">PV<\/jats:styled-content>, although repeat dosing was frequently required. These observations have significant implications for the choice of drugs for this condition.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.12674","type":"journal-article","created":{"date-parts":[[2014,12,23]],"date-time":"2014-12-23T07:11:06Z","timestamp":1419318666000},"page":"284-292","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Treatment outcomes in a cohort of patients with mucosal\u2010predominant pemphigus vulgaris"],"prefix":"10.1111","volume":"45","author":[{"given":"S.","family":"Ojaimi","sequence":"first","affiliation":[{"name":"Department of Clinical Immunology Westmead Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"O'Connor","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology Westmead Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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