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Tetracycline Antibiotics and Niacinamide as Steroid-Sparing Agents for Pemphigus

Summary and Comment |
July 25, 2014

Tetracycline Antibiotics and Niacinamide as Steroid-Sparing Agents for Pemphigus

  1. Jeffrey P. Callen, MD

A dermatologist describes his experience using these low-toxicity, steroid-sparing agents.

  1. Jeffrey P. Callen, MD

Until the advent of systemic corticosteroids, pemphigus was a life-threatening disease. Because of steroid-related toxicity at the doses required for pemphigus treatment, early use of a steroid-sparing agent has become standard practice. Tetracycline antibiotics may have some anti-inflammatory effects, and the addition of niacinamide has been useful in other immunoblistering diseases. The exact mechanism by which these agents might affect immune response in pemphigus is unknown.

These authors reviewed the cases of pemphigus patients treated at a single medical dermatology practice for at least 3 months with a combination of a tetracycline antibiotic (tetracycline, doxycycline, or minocycline) and niacinamide after corticosteroid-induced clinical remission. The analysis included 51 patients: 43 with pemphigus vulgaris, 7 with pemphigus foliaceous, and 1 with pemphigus erythematosus. Response was noted in 43 patients, and there were 5 nonresponders (3 patients were lost to follow-up). Response lasted anywhere from 1 to 13 years. In 13 patients, disease was completely controlled with this regimen; the others received intermittent superpotent topical corticosteroids or oral prednisone. Some patients were serially assessed for pemphigus antibodies, but these data was not available for most of the patients.

Comment

This is an interesting observation of one physician's experience with a steroid-sparing alternative that is inexpensive and relatively safe. The data need to be replicated at other sites before this regimen can be widely accepted as potential steroid-sparing therapy.

  • Disclosures for Jeffrey P. Callen, MD at time of publication Consultant / Advisory board XOMA; Eli Lilly Equity Various trust accounts Editorial boards JAMA Dermatology; UpToDate; Journal of Rheumatology; Psoriasis Forum; Journal of Drugs in Dermatology; eMedicine

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