Positive Direct Immunofluorescence Is of Better Value than ELISA-BP180 and ELISA-BP230 Values for the Prediction of Relapse after Treatment Cessation in Bullous Pemphigoid: A Retrospective Study of 97 Patients

Abstract

Background: ELISA-BP180 values and direct immunofluorescence (DIF) are prognostic factors for relapse after treatment cessation in bullous pemphigoid (BP). Objective: To determine the relevance of ELISA-BP230 antibodies for predicting relapse 6 months after treatment cessation. Methods: We retrospectively selected patients with BP and available data from ELISA-BP180 and -BP230 and DIF performed at treatment cessation. The rate of relapse was calculated at 6 months. We compared ELISA-BP180 and -BP230 values and DIF in patients with relapse and remission. Results: We included 97 patients. At 6 months, 25.6% of patients showed relapse. The proportion of patients with an ELISA-BP230 value ≥27 UA/ml was higher, but not significantly, for those with relapse than for those with remission (p = 0.11). The frequency of positive DIF findings was significantly higher for patients with relapse (p = 0.005). Conclusion: DIF is of better value than ELISA-BP180 and -230 tests to predict relapse after treatment cessation in BP.

Variation of the epidermal expression of glucocorticoid receptor‐beta as potential predictive marker of bullous pemphigoid outcome

“…In BP, like in many other autoimmune diseases, the presence of autoantibodies in serum reflects a failure of tolerance mechanisms on which an inflammatory response may occur . It has been showed that the serum concentration of IgG autoantibodies to BP180 correlated with disease severity and that its fluctuations between days 0, 60 and 150 may predict disease outcome . In this setting, a small decrease in anti‐BP180 IgG serum levels between days 0 and 60 is a factor associated with disease relapse within the first year of treatment .…”

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

“…Among BP patients, 73.8-85% were reported to be treated with systemic corticosteroid [15][16][17] and relapse rates were reported to be 15-53%. 3,5,[18][19][20][21][22][23] This clearly contrasts with pemphigus patients; we recently reported that 62% of pemphigus patients experienced relapse at least once and all of them had been treated with oral PSL. 24 In Japanese guidelines for pemphigoid management, oral PSL (0.5-1 mg/kg) is recommended as a first-line treatment for moderate to severe BP.…”

“…In our study, 37.2% of patients were treated without oral PSL and the relapse rate was less than 10% in those patients (Tables 1 and 4). Among BP patients, 73.8–85% were reported to be treated with systemic corticosteroid 15–17 and relapse rates were reported to be 15–53% 3,5,18–23 . This clearly contrasts with pemphigus patients; we recently reported that 62% of pemphigus patients experienced relapse at least once and all of them had been treated with oral PSL 24 …”

Emerging Biomarkers and Therapeutic Strategies for Refractory Bullous Pemphigoid

“…High titer of anti-BP180NC16AIgG (>27 IU/mL) is the only factor independently predicting the relapse of BP within one year after discontinuation of treatment, and the positive predictive value and the negative predictive value are 90.9% and 51.2%, respectively ( 19 ). However, in another study, positive DIF was of a better value than BP180 IgG ELISA values for predicting the relapse risk, with 59.0% sensitivity, 78.0% specificity, while 50.0% positive predictive values and 83.3% negative predictive value, respectively ( 20 ). When the ELISA-BP180 value was high or DIF shows positive, treatment to BP should not be ceased.…”