Clinical characteristics and outcomes of bullous pemphigoid patients with versus without oral prednisolone treatment

Abstract

Bullous pemphigoid (BP) varies in severity and stratified treatments are needed. However, there are no definitive standards for choosing appropriate treatments. To elucidate the factors involved in choosing treatments and the clinical outcomes of BP, we retrospectively reviewed the clinical records of 78 BP patients at a single center. Of the 78 patients, 49 (62.8%) were treated with oral prednisolone (PSL) and 29 (37.2%) were treated without PSL. The patients with older age, lower Bullous Pemphigoid Disease Area Index (BPDAI), and/or lower anti‐BP180NC16a antibody titer at onset tended to be treated without oral PSL. Notably, only 9.1% patients without PSL experienced relapse, whereas 36.7% patients with oral PSL experienced relapse when the PSL was around 0.1 mg/kg. It suggests that the patients with mild disease severity could be well controlled without oral PSL. Receiver–operator curve analysis demonstrated that the cut‐off value for the use of oral PSL was 31 for total BPDAI and was 7 for BPDAI skin urticaria/erythema, with a high (>0.9) area under the curve. Notably, none of the patients who were negative for the anti‐BP180NC16a antibody at onset experienced relapse even though they were treated without PSL. In conclusion, in BP patients who were negative for anti‐BP180NC16a antibody at onset, with a total BPDAI score of less than 31 or with an urticaria/erythema score of less than 7 can be treated without PSL. When the PSL is tapered to around 0.1 mg/kg, we should carefully monitor the patients to detect relapse.

Clinical severity scores as a guide for prediction of initial treatment responses in pemphigus and pemphigoid patients

“…A previous study reported that 18 cases (36.7%) out of 49 BP patients who were treated with systemic corticosteroids required adjuvant therapies. 21 Many of the patients in this study took 1.0 mg/kg/day of PSL and immunosuppressive agents in addition to corticosteroids as initial treatment, and these situations could have affected the results.…”

Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases

“…In clinically localized or mild cases, superpotent topical corticosteroids (clobetasol propionate) are applied to lesions only or to the whole body except the face as a first choice ( 215 , 216 , 220 ). Low-dose oral corticosteroids, tetracycline (and nicotinamide) and dapsone are also used.…”

“…Non-inferiority was shown in comparison with oral prednisolone (0.5 mg/kg/day), and the safety was significantly higher ( 223 ). Whilst all these treatments, especially those using topical or systemic corticosteroids, induce remission in over 90% of the patients within 4 weeks, relapses during tapering corticosteroids or after stopping treatment are frequent ( 220 , 222 , 224 ). This necessitates prolonged treatment with corticosteroids.…”