Pemfigus vulgaris tedavisinde yenilikler

Year 2013, Volume: 30 Issue: 1s, 1 - 8, 28.11.2013

Müge Güler Özden , Ahmet Turanlı

Abstract

Pemfigus vulgaris mortalitesi, tedavi edilmediğinde % 90’a kadar ulaşabilmektedir. Bu yüksek mortalite oranı sistemik kortikosteroidlerin kullanılmaya başlanmasıyla belirgin olarak düşmekle birlikte, şiddetli yan etkiler ve dirençli olguların varlığı nedeniyle adjuvan tedavi kullanımı hemen her zaman gerekmektedir. Son yıllarda pemfigus tedavisinde yeni bir yön vermeyi amaçlayan çok fazla çalışma yayınlanmaktadır. Amaçlanan, ölümcül sonuçları olmayan yan etkilere sahip, düşük dozda kullanılabilen ve uzun süre remisyon sağlayan tedavi seçenekleri bulmaktır. Sistemik steroidler hızlı remisyon sağlamaları nedeniyle halen ilk tedavi seçeneğidir. Ancak bu tedavinin yan etkileri oldukça fazladır ve dozu azaltabilmek amacıyla bir çok toksik yan etkilere sahip adjuvan tedavi eklenmesine gerek duyulmaktadır. Son yıllarda pemfigus tedavisine yeni bir yön veren yeni tedaviler; intravenöz immünglobulin (IVIg), plazmaferez, immünoadsorbsiyon (İA), ekstrakorporeal fotokemoterapi (EKP), rituksimab, tümör nekrozis faktör alfa (TNF-α) inhibitörleri (infliksimab ve etanercept), kolinerjik agonistler, dezmoglein 3 peptitleri ve KC706 gibi deneysel ajanlardır.

Improvements in the treatment of Pemhigus vulgarism

The mortality of Pemphigus vulgaris can reach up to 90% when it is not treated. Although this ratio has declined together with the use of systemic corticosteroids, there is almost always a need to administer adjuvant treatment because of severe adverse effects and resistant cases. There are many publishings aiming to find a new way for pemphigus treatment, recently. No side effects that lead to fatal results and low-dose treatment with long-term remission have become the issue to find. Systemic steroids due to provide fast remission is still the first treatment option. However, depending on the dose and time, side effects are too much. Therefore, almost always an adjuvan treatment is needed to reduce the dose which have many toxic side effects. Pemphigus treatments giving a new direction in recent years are, intravenous immunoglobulin, plasmapheresis, immunoadsorbtion, ekstracorporeal photochemoterapy, rituximab, tumor necrosis factor alpha inhibitors (infliximab and etanercept), cholinergic agonists and experimental agents such as desmoglein 3 peptides and KC706.

Keywords

Büllöz hastalıklar; pemfigus; pemfigus vulgaris; tedavi (Bullous diseases; pemphigus; pemphigus vulgaris; treatment)

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