Factors Affecting the Duration of Phase 1 of Dexamethasone-Immunosuppressant Pulse Therapy for Pemphigus Group of Disorders: A 10-Year Retrospective Study in a Tertiary Care Center

CONTEXT: Dexamethasone-immunosuppressant pulse therapy introduced by Pasricha et al. in 1981 as a treatment for long-term remission in pemphigus group of disorders has gained wide acceptance in many places, especially India. Since the overall duration of treatment is determined by the duration of phase 1 of the regime, identification of factors that influence phase 1 may be particularly helpful in addressing patient's concerns and apprehensions before initiation of treatment so that compliance can be improved. AIMS: To find out factors that affect the duration of phase 1 of dexamethasone-immunosuppressant pulse therapy. SUBJECTS AND METHODS: A 10-year retrospective study from medical records of 37 patients was conducted. The severity of pemphigus was assessed using Kumar's scoring system. The mean duration of phase 1 compared between the variables and significance of association was found out using Student's t-test. Patients were further classified in to two groups: with phase 1 duration ≤6 months and >6 months. Chi-squared and Fisher's exact tests were done to find out factors which significantly contribute to prolonged induction phase. RESULTS: A significant association was noticed between total severity score and mean duration of phase 1 (P = 0.031). Significant association was also noticed between prolonged induction phase of >6 months and oral mucosal severity score >2 (P = 0.017). Other patient factors, type of pulse therapy, and comorbidities had no effects on the duration of phase 1. CONCLUSIONS: Duration of phase 1 is expected to prolong if the total severity score is >3, and when oral severity score is >2 it is likely to be more than 6 months.