Re‐evaluation of the natural course of bullous pemphigoid. A prospective study

Abstract

The lack of parameters with predictive importance underlines the necessity of a thorough follow-up to prevent treatment-related complications in elderly patients.

Risk Factors for Relapse in Patients With Bullous Pemphigoid in Clinical Remission

“…Until now, 2 retrospective studies were unable to identify any clinical features that could prospectively identify particular subgroups of patients with BP with predictable outcomes, including relapses after discontinuation of treatment. 6,26 Similarly, in our prospective study, no clinical or biological characteristics at the time of diagnosis were predictive of outcome after cessation of therapy. On the contrary, we identified 2 immunologic characteristics at the time of cessation of therapy associated with an increasing risk of further relapse of BP on univariate analysis, ie, a positive finding on direct IF microscopy and a high titer of BP180 antibodies by ELISA.…”

“…Dosages of 10 to 30 g/d frequently are sufficient to control the disease, with rapid tapering and cessation of therapy within 4 months. 22 In fact, in patients with BP, corticosteroids are generally the most common maintenance therapy 15 and the preferred treatment of relapses, 26 although recent studies favor methotrexate 25 or immunosuppressive agents 19 as maintenance therapy. In a recent retrospective study, only 10% of patients re- quired prolonged systemic corticosteroid treatment with a mean follow-up of 26 months.…”

Prognostic clinical factors associated with remission and relapse in bullous pemphigoid

“…However, no statistically significant differences in relapse rates were found between these two groups. There have been only four previous studies on clinical predictive factors for BP relapse . Although Fichel et al .…”

Clinical and Immunologic Factors Associated With Bullous Pemphigoid Relapse During the First Year of Treatment

“…22 During the 1-year follow-up period, 35% of the study patients experienced at least 1 relapse, which is consistent with previous clinical trials. 23,24,46 Most relapses occurred within the first year of treatment, and the mean time to relapse was approximately 5 months. The relapse-free survival curve shows that relapses in patients with BP with associated dementia occurred mainly after day 150.…”