Methotrexate is an effective and safe adjuvant therapy for pemphigus vulgaris

Background: Pemphigus vulgaris (PV) is a chronic, autoimmune blistering disease. Most patients require long term therapy with systemic steroids as a first line of treatment. Immunosuppressive agents such as methotrexate (MTX) are administratedassecond line therapy. Onlyafew reports have assessed MTX efficacy, with contradictory results. Objective: The aim of this study was to evaluate MTX as an adjuvant therapy in patients with PV. Methods: A retrospective study of 30 PV patients treated with MTX as an adjuvant therapy. Disease severity score and prednisone dosage served as assessing measures. Results: All patients were treated with 15mg MTX per week. Of the 25 patients defined as severe or moderate disease at the beginning of treatment, 21 (84%) improved and downgraded their severity status at 6 months of treatment. In 21 patients (76.6%) we were able to reduce the prednisone dose. There was a significant improvement in the severity score (p=0.00001) and in prednisone dose (p=0.0001). Four patients (13%) suffered from mild side effects. Conclusion: MTX treatment is safe and beneficial as a steroid-sparing agent in PV.