Controlled trial of azathioprine and plasma exchange in addition to prednisolone in the treatment of bullous pemphigoid
J. C. Guillaume, L. Vaillant, P. Bernard, C. Picard, C. Prost, B. Labeille, B. Guillot, C. Foldes-Pauwels, F. Prigent, P. Joly and al. et
Department of Dermatology, Hopital H. Mondor, Creteil, France.
BACKGROUND AND DESIGN. Bullous pemphigoid is usually treated with systemic
corticosteroids. Side effects are common in elderly patients, justifying
the search for adjuvant therapy. This randomized, multicentric unblind
study was designed to assess the efficacy of azathioprine or plasma
exchange when added to conventional doses of prednisolone. One hundred
patients with active disease entered the study. They were randomly
allocated to receive 28 days of treatment with oral prednisolone sodium
metasulfobenzoate (1 mg/kg per day) either alone or in combination with
oral azathioprine (100 to 150 mg/d) or four large-volume plasma exchanges.
After 28 days, the prednisolone doses were progressively decreased
according to the same strict regimen in the three groups (in combination
with oral azathioprine in group 2). RESULTS. The clinical results were
evaluable in 98 of the 100 patients included in the study. There was no
appreciable difference in the percentages of complete remission of the
disease in the three therapeutic groups at 28 days (71%, 80%, and 71%,
respectively) or at 6 months (42%, 39%, and 29%, respectively). Severe
complications were more often observed among patients receiving
azathioprine. At 6 months, 14 of 98 patients had died, without any
differences noted among the three study groups. CONCLUSIONS. We conclude
that neither azathioprine nor plasma exchange is effective enough to be
used routinely as an adjuvant to corticosteroids in the management of
bullous pemphigoid.
A Retrospective Analysis of Patients With Bullous Pemphigoid Treated With Methotrexate
Kjellman et al.
Arch Dermatol 2008;144:612-616.
ABSTRACT
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A Comparison of Oral Methylprednisolone Plus Azathioprine or Mycophenolate Mofetil for the Treatment of Bullous Pemphigoid
Beissert et al.
Arch Dermatol 2007;143:1536-1542.
ABSTRACT
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Prediction of Survival for Patients With Bullous Pemphigoid: A Prospective Study
Joly et al.
Arch Dermatol 2005;141:691-698.
ABSTRACT
| FULL TEXT
Risk Factors for Lethal Outcome in Patients With Bullous Pemphigoid: Low Serum Albumin Level, High Dosage of Glucocorticosteroids, and Old Age
Rzany et al.
Arch Dermatol 2002;138:903-908.
ABSTRACT
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A Systematic Review of Treatments for Bullous Pemphigoid
Khumalo et al.
Arch Dermatol 2002;138:385-389.
ABSTRACT
| FULL TEXT
A Comparison of Oral and Topical Corticosteroids in Patients with Bullous Pemphigoid
Joly et al.
NEJM 2002;346:321-327.
ABSTRACT
| FULL TEXT
Bullous Pemphigoid Therapy -- Think Globally, Act Locally
Stern
NEJM 2002;346:364-367.
FULL TEXT
Prednisone Is More Effective Than Prednisolone Metasulfobenzoate in the Treatment of Bullous Pemphigoid
Lebrun-Vignes et al.
Arch Dermatol 1999;135:89-90.
FULL TEXT
Bullous Pemphigoid: The Latest in Diagnosis, Prognosis, and Therapy
Korman
Arch Dermatol 1998;134:1137-1141.
FULL TEXT
High Risk of Death in Elderly Patients With Extensive Bullous Pemphigoid
Roujeau et al.
Arch Dermatol 1998;134:465-469.
ABSTRACT
| FULL TEXT
Management of Acquired Bullous Skin Diseases
Fine
NEJM 1995;333:1475-1484.
FULL TEXT
Adjuvant Therapy for Bullous Pemphigoid: No Benefit
Journal Watch Dermatology 1993;1993:1-1.
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