Assessment of adherence to topical corticosteroids in patients with bullous pemphigoid

Sobocinski, V.; Duvert‐Lehembre, S.; Bubenheim, Michael; Lesage, C.; Bernard, Philippe; Bénichou, Jacques; Joly, P.

doi:10.1111/bjd.14285

Cited by 12 publications

(5 citation statements)

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“…Although previous studies 3 , 13 have shown good blister control and better safety for prolonged use of super-potent topical corticosteroids over the whole body when compared with high-dose oral prednisolone (mg/kg per day), such a regimen might be impractical for some patients and carers. 24 Prolonged topical corticosteroid use also causes adverse effects such as skin thinning, and those effects associated with systemic absorption. 3 , 13 Most guidelines still recommend oral prednisolone (between 0·5 mg/kg per day and 1·5 mg/kg per day according to initial severity).…”

Section: Discussionmentioning

confidence: 99%

Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial

et al. 2017

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SummaryBackgroundBullous pemphigoid is a blistering skin disorder with increased mortality. We tested whether a strategy of starting treatment with doxycycline gives acceptable short-term blister control while conferring long-term safety advantages over starting treatment with oral corticosteroids.MethodsWe did a pragmatic, multicentre, parallel-group randomised controlled trial of adults with bullous pemphigoid (three or more blisters at two or more sites and linear basement membrane IgG or C3). Participants were randomly assigned to doxycycline (200 mg per day) or prednisolone (0·5 mg/kg per day) using random permuted blocks of randomly varying size, and stratified by baseline severity (3–9, 10–30, and >30 blisters for mild, moderate, and severe disease, respectively). Localised adjuvant potent topical corticosteroids (<30 g per week) were permitted during weeks 1–3. The non-inferiority primary effectiveness outcome was the proportion of participants with three or fewer blisters at 6 weeks. We assumed that doxycycline would be 25% less effective than corticosteroids with a 37% acceptable margin of non-inferiority. The primary safety outcome was the proportion with severe, life-threatening, or fatal (grade 3–5) treatment-related adverse events by 52 weeks. Analysis (modified intention to treat [mITT] for the superiority safety analysis and mITT and per protocol for non-inferiority effectiveness analysis) used a regression model adjusting for baseline disease severity, age, and Karnofsky score, with missing data imputed. The trial is registered at ISRCTN, number ISRCTN13704604.FindingsBetween March 1, 2009, and Oct 31, 2013, 132 patients were randomly assigned to doxycycline and 121 to prednisolone from 54 UK and seven German dermatology centres. Mean age was 77·7 years (SD 9·7) and 173 (68%) of 253 patients had moderate-to-severe baseline disease. For those starting doxycycline, 83 (74%) of 112 patients had three or fewer blisters at 6 weeks compared with 92 (91%) of 101 patients on prednisolone, an adjusted difference of 18·6% (90% CI 11·1–26·1) favouring prednisolone (upper limit of 90% CI, 26·1%, within the predefined 37% margin). Related severe, life-threatening, and fatal events at 52 weeks were 18% (22 of 121) for those starting doxycycline and 36% (41 of 113) for prednisolone (mITT), an adjusted difference of 19·0% (95% CI 7·9–30·1), p=0·001.InterpretationStarting patients on doxycycline is non-inferior to standard treatment with oral prednisolone for short-term blister control in bullous pemphigoid and significantly safer in the long-term.FundingNIHR Health Technology Assessment Programme.

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Section: Discussionmentioning

confidence: 99%

Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial

et al. 2017

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“…had not yet been published . Even to date, in many patients with BP, the long‐term use of topical corticosteroids is challenging due to old age, comorbidities and commonly required support by relatives and the healthcare system . This has led to the recommendation of oral corticosteroids as first‐line therapy for moderate and severe BP in the U.K. and German treatment guidelines …”

Section: Discussionmentioning

confidence: 99%

An open, multicentre, randomized clinical study in patients with bullous pemphigoid comparing methylprednisolone and azathioprine with methylprednisolone and dapsone

et al. 2017

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“…die in der Studie verwendete 2-mal tägliche topische Ganzkörpertherapie über viele Wochen oft nur schwer umzusetzen [10]. Das erklärt auch, warum in der klinischen Praxis eine rein topische Therapie in der Regel nicht ausreichend ist.…”

Section: Bullous Pemphigoid • Autoimmune Blistering Disease • Autoimmune Disease • Therapy • Rituximabunclassified

“…Systemische Glukokortikoide sind die primäre rasch wirksame Systemtherapie des bullösen Pemphigoids. Da eine intensive Lokaltherapie in schweren Fällen oft nicht suffizient durchführbar ist [10], stellen sie nach wie vor ein zentrales Standbein der Therapie des bullösen Pemphigoids dar. Die übliche Anfangsdosis liegt zwischen 0,5 und 1 mg/kg Körpergewicht Prednisolon/Tag, wobei höhere Dosen mit einer deutlichen Zunahme der Nebenwirkungen assoziiert und auch nicht bedeutend wirksamer sind [11].…”

Section: Systemische Glukokortikoideunclassified

Neue Therapiemöglichkeiten des bullösen Pemphigoids

Griss

2021

hautnah

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ZusammenfassungDas bullöse Pemphigoid ist die häufigste autoimmun-blasenbildende Hauterkrankung. Es betrifft fast ausschließlich Patienten im fortgeschrittenen Alter und damit eine von vornherein vulnerable Patientenpopulation. Aufgrund seiner laufend steigenden Inzidenz wird das bullöse Pemphigoid zu einer immer größeren Belastung für Gesundheitssysteme. In dieser Arbeit sollen die primären klinischen Erscheinungsformen des bullösen Pemphigoids und deren Diagnostik besprochen werden. Der Schwerpunkt liegt jedoch in einer Übersicht bestehender Therapien und der Studienlage zu deren Wirksamkeit. Gerade für schwere Verläufe stellt neuerdings eine Therapie mit Rituximab einen großen Fortschritt in den therapeutischen Möglichkeiten dar. Abschließend werden die Daten einer IgE-Blockade mit Omalizumab bzw. mit einer Blockade von IL-4/IL-13 mittels Dupilumab vorgestellt. Diese neuen Therapien zeigen bereits eine vielversprechende Wirksamkeit und sind spannende Optionen zur Behandlung dieser immer häufiger werdenden Erkrankung.

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Assessment of adherence to topical corticosteroids in patients with bullous pemphigoid

Cited by 12 publications

References 12 publications

Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial

Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial

An open, multicentre, randomized clinical study in patients with bullous pemphigoid comparing methylprednisolone and azathioprine with methylprednisolone and dapsone

Neue Therapiemöglichkeiten des bullösen Pemphigoids

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