IMPROVING PROPHYLACTIC AND REHABILITATION APPROACHES TO PREVENT RELAPSE IN PEMPHIGUS VULGARIS: A PROSPECTIVE COHORT STUDY ON BIOMARKER-GUIDED PATIENT MANAGEMENT
Keywords:
Pemphigus Vulgaris, Relapse, Prevention, Prophylaxis, Rehabilitation, Autoimmunity, Anti-Desmoglein Antibodies, Quality of Life, Biomarker-Guided Therapy.Abstract
To evaluate the efficacy of a comprehensive prophylactic and rehabilitation program, guided by anti-desmoglein (Dsg) antibody titers, in preventing relapses in patients with pemphigus vulgaris (PV) in clinical remission. Methods: A 3-year prospective, controlled cohort study was conducted at the national dermatology center. 120 patients with PV in complete remission (on minimal therapy or off therapy) were enrolled and allocated into two groups. The Intervention Group (IG, n=60) entered a "Comprehensive Rehabilitation and Prophylactic Program" (CRPP), which included: quarterly anti-Dsg1/Dsg3 ELISA monitoring, proactive patient education on triggers (diet, stress, infections), dental/ENT sanitation, and structured psychological support. The Control Group (CG, n=60) received the standard of care (SOC), involving routine clinical follow-up every 3-6 months. A pre-defined protocol in the IG allowed for prophylactic therapy escalation (e.g., temporary increase in topicals, initiation of dapsone, or small pulse of steroids) if a significant (>75%) rise in antibody titers was detected, even without clinical symptoms. Results: The relapse rate at 36 months was significantly lower in the Intervention Group (IG: 18.3%, 11/60 patients) compared to the Control Group (CG: 46.7%, 28/60 patients; p < 0.001). The median relapse-free survival time in the CG was 21 months, whereas it was not reached in the IG. In the IG, 19 patients showed a significant biomarker rise; 16 of these were managed prophylactically, and only 3 (15.8%) progressed to a full clinical relapse. In the CG, 25 of the 28 relapses were preceded by high antibody titers (measured at relapse). The IG also reported significantly lower cumulative corticosteroid dosage (p < 0.05) and superior Dermatology Life Quality Index (DLQI) scores (p < 0.01). Conclusion: A structured prophylactic and rehabilitation program, centered on immunological (anti-Dsg) monitoring and proactive patient management, significantly reduces the frequency and severity of relapses in pemphigus vulgaris. This "biomarker-guided" approach is superior to standard reactive care and should be considered a new standard for long-term pemphigus management.
Downloads
References
Amagai, M., & Stanley, J. R. (2017). Pemphigus. In K. Wolff, L. A. Goldsmith, S. I. Katz, B. A. Gilchrest, A. S. Paller, & D. J. Leffell (Eds.), Fitzpatrick’s Dermatology in General Medicine (9th ed., pp. 588–602). McGraw-Hill.
Мухаммаджонова, Л. (2025). MODERN TREATMENT OF ONYCHOMYCOSIS. Международный мультидисциплинарный журнал исследований и разработок, 1(1).
Joly, P., Maho-Vezin, F., & Z-Y, T. (2017). First-line rituximab combined with short-term prednisone in pemphigus (Ritux 3): A prospective, multicentre, parallel-group, open-label randomised trial. The Lancet, 389(10083), 2031–2040. https://doi.org/10.1016/S0140-6736(17)30070-3
Akiljanovna, M. L. (2024). THE COURSE OF PSORIASIS IN YOUNG AND OLD CHILDREN. Ethiopian International Journal of Multidisciplinary Research, 11(03), 205-207.
Murrell, D. F., Dick, S., Ahmed, A. R.,... & Joly, P. (2020). Definitions and outcome measures for pemphigus and pemphigoid: A consensus statement by the International Pemphigus and Pemphigoid Foundation. Journal of the American Academy of Dermatology, 82(3), 575–582.
Sertznig, P., Loquai, C., & H-L, S. (2018). Correlation of anti-desmoglein-1 and -3 antibody titers and clinical disease activity in pemphigus. Journal of the German Society of Dermatology, 16(11), 1332-1337. https://www.google.com/search?q=https://doi.org/10.1111/ddg.13682
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in the Journal of Applied Science and Social Science (JASSS) is protected by copyright. Authors retain the copyright to their work, and grant JASSS the right to publish the work under a Creative Commons Attribution License (CC BY). This license allows others to distribute, remix, adapt, and build upon the work, even commercially, as long as they credit the author(s) for the original creation.
