Glucocorticoids Combined With Systemic Adjuvant Therapy In The Treatment Of Pemphigus:A Systematic Review And Meta-analysis

Objective:To systematically review the efficacy and safety of oral glucocorticoids combined with systemic adjuvant therapies in the treatment of pemphigus.Methods:The Pubmed database,Embase database,Cochrane library,Sinomed database,CNKI database,Wanfang database,VIP database were searched to collect all the randomized controlled clinical trials of glucocorticoids combined with systemic adjuvant therapies for pemphigus treatment.According to inclusion and exclusion criteria,literatures were screened,the quality of methods included in the study were evaluated,and data were extracted.Meta-analysis was performed using revMan5.3 software.Results:A total of 12 randomized controlled trials were enrolled,including a follow-up report of an already included trial.They included a total of 649 patients.Meta-analysis showed that glucocorticoids combined with rituximab had a higher rate of remission compared with oral glucocorticoids alone in the treatment of pemphigus[RR=2.61,95%CI(1.71,3.99),P<0.00001];Glucocorticoids combined with intravenous immunoglobulin had a higher rate of disease control in the treatment of pemphigus compared with oral glucocorticoids alone[RR=1.84,95%CI(1.11,3.05),P=0.02];Glucocorticoids combined with adjuvant therapies comparing with oral glucocorticoids alone,the recurrence rate was statistically significant lower[RR=0.67,95%CI(0.51,0.88),P=0.94];Glucocorticoids combined with rituximab[MD=-11830.50,95%CI(-14089.48,-9571.52),P<0.00001],cyclophosphamide[MD=-3355.00,95%CI(-6143.57,-566.43),P=0.02)]and azathioprine[MD=-2240.25,95%CI(-4875.81,-4.70),P=0.14]were statistically significant in reducing the cumulative glucocorticoid dose compared to glucocorticoids alone.There was no statistically significant difference in withdrawal due to adverse events.Conclusion:Glucocorticoids combined with adjuvant therapy is more conducive to reducing the recurrence of pemphigus than glucocorticoids alone.The combination of some adjuvant therapy may be more helpful for the relief of the disease or reduce the cumulative glucocorticoid dose,but it still needs more large-scale randomized controlled trials to verify the conclusion.