Effect Of Autologous Serum Therapy (AST) As Adjuvant In Pemphigus Vulgaris: A Pilot Study

Abstract

Introduction: Pemphigus vulgaris (PV) is an autoimmune disease characterized by vesicles and bullae on the skin and mucosa due to autoantibody reactions to the desmosomal adhesion molecules desmoglein (Dsg)1 and 3, which function as adhesion between keratinocytes. Autologous Serum Therapy (AST) can be used as an adjuvant management of PV by reducing the use of steroid doses and accelerating the healing process. The mechanism of action of AST is by inducing desentization of PV patients' autoreactivity to proinflammatory signals. The aim of this study was to determine the effectiveness of AST to reduce PV disease activity and minimize the use of high doses of systemic CS. Method: The research method used an experimental one group pretest - posttest design in PV patients at the Dermatology Venereology and Aesthetics clinic of Dr. Mohammad Hoesin Palembang Central General Hospital during the study period. Result: This pilot study included 6 PV patients who met the inclusion criteria and received AST therapy. The mean pemphigus disease area index (PDAI) score was 20.00 before AST therapy and 10.67 after AST therapy. The T test results obtained a p value of 0.014, which means that there is a statistically significant difference in the decrease in PDAI scores in pemphigus vulgaris patients before and after AST therapy. The therapy can reduce DLQI scores from a mean of 20.00 before AST therapy to 14.67 after AST therapy. The results of the T test obtained a p value of 0.009 means that there is a statistically significant difference in the decrease in dermatology life quality index (DLQI) scores in pemphigus vulgaris patients before and after AST therapy. Conclusion: Autologous serum therapy has good effect on PDAI and DLQI score with minimal side effects in the treatment of PV. Partial remission on therapy occurred in 2 patients after a period of AST administration. Further studies with controlled research design, large sample size and minimum 1 year follow-up period are needed to confirm this study.