Controlled trial of azathioprine and plasma exchange in addition to prednisolone in the treatment of bullous pemphigoid

Guillaume, J

doi:10.1001/archderm.129.1.49

Cited by 57 publications

(74 citation statements)

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“…A subsequent study also failed to show any difference in disease control (defined as no new blister formation) at the 28-day and 6-month follow-up when azathioprine was added to prednisone treatment (prednisone alone 1 mg/kg/d, n = 31; prednisone 1 mg/kg/d plus azathioprine 100 to 150 mg/d, n = 36) 28 ; however, the steroid-sparing ability of adding azathioprine was not reported as an outcome measure.…”

Section: Bullous Pemphigoidmentioning

confidence: 98%

“…58 The steroid-sparing effect of plasmapheresis was corroborated in 2 studies 59,60 ; however, a third study failed to show any benefit when plasma exchange was added to prednisolone. 28 Given its cost and associated risk, plasmapheresis is best reserved for patients with recalcitrant disease that does not respond to more standard therapy.…”

Section: Bullous Pemphigoidmentioning

confidence: 99%

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Treatment of subepidermal immunobullous diseases

Culton

Díaz

2012

Clinics in Dermatology

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The subepidermal immunobullous diseases are a group of autoimmune blistering disorders of the skin and mucous membranes that share the common features of autoantibody deposition and blister formation at the dermal-epidermal junction or basement membrane. This group includes bullous pemphigoid, linear IgA disease, dermatitis herpetiformis, and epidermolysis bullosa acquisita, among others. Although these disorders share some common features, each disease is unique in its clinical presentation, histopathology, and immunofluorescence patterns, which allows for accurate diagnosis and disease-specific treatment strategy. Treatment of these disorders is complex and requires expert knowledge of disease pathogenesis. We review common treatment approaches for each of these disorders.

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Section: Bullous Pemphigoidmentioning

confidence: 98%

Section: Bullous Pemphigoidmentioning

confidence: 99%

Treatment of subepidermal immunobullous diseases

Culton

Díaz

2012

Clinics in Dermatology

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“…Making rapidly the proper diagnosis of these diseases is important to propose the appropriate therapy, since BP is successfully treated with topical or systemic corticosteroids, whereas immunosuppressive agents such as ciclosporine or cyclophosphamide are often used in EBA and CP patients, respectively, despite the fact that no controlled study has clearly demonstrated a benefit from the addition of these immunosuppressive drugs to corticosteroid therapy [15, 16, 17, 18]. Moreover, a rapid and reliable differentiation between these diseases is also required for multicenter studies, especially epidemiological studies and therapeutic trials [18].…”

Section: Introductionmentioning

confidence: 99%

Clinical Criteria for the Diagnosis of Bullous Pemphigoid: A Reevaluation according to Immunoblot Analysis of Patient Sera

et al. 2004

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Background: We previously proposed a set of 4 clinical criteria for the diagnosis of bullous pemphigoid (BP) that consisted of age greater than 70 years, absence of atrophic scars, absence of mucosal involvement and absence of predominant bullous lesions on the neck and head. These results have been challenged because direct immunoelectron microscopy (IEM), which was used as the standard diagnostic criterion in our initial study, does not identify the different antigens of the basement membrane zone. Objective: To reassess the validity of these clinical criteria for the diagnosis of BP using immunoblot analysis of patient sera as the main diagnostic criterion, in order to precisely identify the antigens recognized by patient sera. Methods: One hundred and eighty-nine sera from patients with various subepidermal autoimmune blistering diseases (AIBDs) were tested by immunoblotting using dermal and epidermal extracts. IEM was used as a complementary diagnostic procedure in a few patients whose serum recognized BPAG2 exclusively or was negative in immunoblotting. Results: 142 patients (75%) had at least 3 of the 4 clinical diagnostic criteria. Sera from patients who lacked the set of BP clinical criteria were more frequently immunoblot negative (34%) than sera from patients who had the criteria (18%; p = 0.025). BPAG1 was more frequently recognized by sera from patients with the set of BP clinical criteria (78%) than by sera from patients without the criteria (45%; p = 5·10^–4). In contrast, BPAG2 was recognized by a great number of sera from patients who lacked the criteria of BP (71%), which was in accordance with the presence of numerous patients with cicatricial pemphigoid in this group. Among patients with various subepidermal AIBDs, the diagnosis of BP could be made with a sensitivity of 86%, a specificity of 90% and an excellent prognostic positive value over 95%, if 3 of these clinical criteria were present. Conclusion: These results confirm the interest of this set of clinical criteria for the rapid diagnosis of BP.

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“…This beneficial effect of adding plasma exchange was not replicated in a later study, 4 where no differences in remission or death rates were found in patients treated with prednisolone alone, prednisolone combined with azathioprine, or prednisolone combined with 4 large-volume plasma exchanges. The azathioprine group did have more serious adverse events (15 patients of 36, including 6 deaths).…”

Section: Commentmentioning

confidence: 86%

“…4,5 Roujeau et al 5 compared prednisolone with and without plasma exchange. They found that the addition of plasma exchange reduced the amount of steroid required and made remission possible (disease control was achieved in 13 of 22 participants compared with none in the prednisolone-only group).…”

Section: Commentmentioning

confidence: 99%

Randomized Controlled Trials Needed for Bullous Pemphigoid Interventions

ía-Romero¹

2012

Arch Dermatol

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Controlled trial of azathioprine and plasma exchange in addition to prednisolone in the treatment of bullous pemphigoid

Cited by 57 publications

References 0 publications

Treatment of subepidermal immunobullous diseases

Treatment of subepidermal immunobullous diseases

Clinical Criteria for the Diagnosis of Bullous Pemphigoid: A Reevaluation according to Immunoblot Analysis of Patient Sera

Randomized Controlled Trials Needed for Bullous Pemphigoid Interventions

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