Comparative Effectiveness of Azathioprine or Mycophenolate Mofetil as an Adjuvant for the Treatment of Bullous Pemphigoid

British Association of Dermatologists’ guidelines for the management of bullous pemphigoid 2012

“…There was no difference between the two treatments, although MMF was slightly slower to produce remission than azathioprine (median 42 days compared with 28·6 days). Both treatments were associated with similar numbers of adverse events, with MMF being associated with more infections but less hepatotoxicity than azathioprine 42,43 . As discussed in , MMF is considerably more costly than azathioprine.…”

“…Both treatments were similarly effective at preventing relapses and had similar numbers of adverse events. Hepatotoxicity was documented in six out of 37 patients treated with azathioprine but more infections occurred with MMF 42,43 . Although the treatments were equally effective, the 5·5‐fold higher cost of MMF (2 g daily) compared with azathioprine (2 mg kg −1 daily for a 75‐kg patient) could be an important consideration in some health economies.…”

“…Both treatments were associated with similar numbers of adverse events, with MMF being associated with more infections but less hepatotoxicity than azathioprine. 42,43 As discussed in section 8.3, MMF is considerably more costly than azathioprine. Further evidence is needed for the role of MMF in BP.…”

Pemphigoid – diagnosis and treatment. Polish Dermatological Society Consensus

“…W wyjątkowych przypadkach możliwe jest rozważenie zastosowania poniższych leków, ale ich skuteczność nie została potwierdzona: -azatiopryna -1-2,5 mg/kg m.c./dobę -wskazane badanie stężenia enzymu metabolizującego azatioprynę -tiopurynowej metylotransferazy (TPMT) [59,60], -mykofenolan mofetylu -2 g/dobę lub mykofenolan sodowy 1,44 g/dobę [59,60], -dapson -do 1,5 mg/kg m.c./dobę [61], -cyklofosfamid -1-3 mg/kg m.c./dobę p.o. lub w postaci pulsów i.v.…”

“…W przypadku BP opornego na leczenie miejscowe klobetazolem i terapię prednizonem należy rozważyć metody alternatywne: -metotreksat, azatioprynę, mykofenolan mofetylu [57][58][59][60], -immunoglobuliny dożylne (trzeci stopień wiarygodności) [62], -immunoadsorpcję (czwarty stopień wiarygodności) [63], -leki biologiczne: anty-CD20 (rytuksymab), anty--IgE (omalizumab) (czwarty stopień wiarygodności) [64,65], -cyklofosfamid (trzeci stopień wiarygodności) [51], -wymianę plazmy (pierwszy stopień wiarygodności) [66].…”