Yearly reduction of glucocorticoid dose by 50% as tapering schedule achieves complete remission for 124 pemphigus vulgaris patients

Glucocorticoids are the first-line treatment for pemphigus vulgaris. Among 140 patients receiving systemic glucocorticoids, 124 patients achieved complete remission off or on a prednisone dose of 10mg/day or less for 6months or more. The mean average steroid controlling doses were 0.65, 0.62, 0.80, 1.08 and 1.38mg/kg per day for the mucosal-dominant patients and the mild, moderate, severe and extensive cutaneous-involved patients, respectively (P<0.001). The mean durations of the initial tapering after controlling doses started were 77.98, 48.78, 31.74 and 28.83days when the disease was controlled with doses of 40mg/day or less, 45-60mg/day, 65-80mg/day and more than 80mg/day for the cutaneous-involved types, respectively (P<0.005). Of the patients, 79.51% achieved complete remission within 3years, 98.36% within 5years and all within 6years, which corresponded to a 50% yearly reduction of glucocorticoid dose. These successfully treated patients indicate that a severity-tailored initial dose of glucocorticoids, an initial tapering duration based on the initial dose and a subsequent 50% yearly tapering regimen may cure pemphigus vulgaris within 3-6years.National Natural Science Foundation of China [81130030, 81000694]; Beijing Natural Science Foundation [7154244]SCI(E)PubMedARTICLExixue_chen@163.com; bjzhuxj@163.com3,SI325-3284