Determination of the value of anti-desmoglein-1 and anti-desmoglein-3 ELISA test in follow-up of patients with pemfigus vulgaris

Pemphigus is a group of chronic autoimmune bullous diseases that target desmosomal proteins and result in keratinocyte detachment in the epidermis. Pathogenic IgG autoantibodies against to desmosomal transmembrane glycoproteins have been identified in pemphigus. Anti-Dsg antibodies measured by ELISA are important in the diagnosis and classification of PV, which has high morbidity and mortality rates due to its chronic course and requires long-term immunosuppressive therapy, and in monitoring the disease activity. This study, it was aimed to define the clinical and demographic characteristics of patients with PV, and to determine the relationship between antibodies against dsg-1 and dsg-3 with clinical phenotype, disease activity, response to treatment, and predicting relapse. In this study, between January 2014 and December 2020; 102 patients with PV, who were followed up at our Bullous Diseases Unit (Dermatology and Venereology Department, Akdeniz University), were evaluated retrospectively. The patients were followed for an average of 42.97±17.43 months. When the anti-Dsg measurements were retrospectively scanned in the study, it was found that the baseline anti-Dsg-1 average of the cases evaluated in the study was 46.34 (n=85, Med.=0.00) and the baseline anti-Dsg-3 average was 108.32 (n=34, Med.=106.00) . The average of anti-Dsg-1 in the third month was 16.14 (n=91, Med.=0.00) and the average of anti-Dsg-3 in the third month was 57.29 (n=78, Med.=40.50) . The average of anti-Dsg-1 at the sixth month was 9.71 (n=90, Med.=0.00) and the average of anti-Dsg-3 at the sixth month was 39.84 (n=78, Med.=0.00). After the initial treatment, the cases achieved complete remission with minimal treatment in an average of 5.24±2.19 months. It was found that the average of anti-dsg-1 and anti-dsg-3 at baseline decreased statistically significantly during the remission period. At least one relapse was observed in 73 (71.6%) patients after initial remission. The average of anti-Dsg-3 value during mucosal relapse was significantly higher than the average of during remission. The average of anti-Dsg-1 and anti-Dsg-3 values during mucocutaneous relapse were significantly higher than the average of during remission. During cutaneous relapse, the average of anti-Dsg-1 value was significantly higher than the average of during remission. The sensitivity and specificity values were 0.79 and 0.83 respectively in ROC analysis performed for anti-Dsg-3 with 57.5 cut-off score 3 months before mucocutaneous relapse time. As a result, the use of serial ELISA tests in the follow-up of PV patients provides data that may be useful in the treatment an important skin disease such as PV, which may have mortality.