cqvip:Objective: To determine the effect of dapsone on glucocorticoid-dependent patients with active or maintenance-phase pemphigus vulgaris. Design: Retrospective study of consecutive patients treated with dapsone. Setting: University of Pen nsylvania, Philadelphia (a tertiary referral hospital). Patients: We observed 9 consecutive adult patients with pemphigus vulgaris being treated with immunosuppressants who were unable to taper prednisone use without abrupt worsening of their disease. Interventions: Dapsone treatment added to prednisone and other immunosuppressive therapy. Main Outcome Measure: Steroid dosage. Results: All patients were unable to taper their steroid dose during the 3 months prior to the initiation of dapsone therapy or had active disease that was not well controlled by prednisone prior to dapsone treatment. With the exception of 1 patient with uncontrolled disease, all 9 patients were able to taper their steroid dose below the adrenal replacement level during dapsone treatment. Maintenance-phase patients taking 15 mg/d or more of prednisone (n=5) experienced a mean±SEM drop of 67%±7.1%in prednisone dose by 4 months of maximal dapsone treatment and an 84%±3.5%drop in prednisone dose after 8 months of dapsone treatment. Conclusions: These retrospective study findings suggest that dapsone reduces steroid dependence in patientswith pemphigus vulgaris, provided they are in themaintenance phase of their disease. These data support the need for a prospective, randomized trial to confirm these findings.
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