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Evidence summaries

Interventions for Bullous Pemphigoid

Very potent topical steroids may be effective and safe treatments for bullous pemphigoid, but their use in extensive disease may be limited by side effects and practical factors. Starting doses of prednisolone greater than 0.75 mg/kg/day do not seem to give additional benefit over smaller doses. Level of evidence: "C"

A Cochrane review (abstract , review [Abstract]) included 10 studies with a total of 1 049 patients. All studies involved different comparisons, none included a placebo group. In 1 study, plasma exchange plus prednisone gave significantly better disease control at 1 month (RR 18.78, 95% CI 1.20 to 293.70) than prednisone alone (RR 1.79, 95% CI 1.11 to 2.90), while another study showed no difference in disease control at 6 months. No differences in disease control were seen for different doses or formulations of prednisolone (1 study each), for azathioprine plus prednisone compared with prednisone alone (1 study), for prednisolone plus azathioprine compared with prednisolone plus plasma exchange (1 study), for prednisolone plus mycophenolate mofetil or plus azathioprine (1 study), for tetracycline plus nicotinamide compared with prednisolone (1 study). Chinese traditional medicine plus prednisone was not effective in one study.There were no significant differences in healing in a comparison of a standard regimen of topical steroids (clobetasol) with a milder regimen (RR 1.00, 95% 0.97 to 1.03) in one study. In another study, clobetasol showed significantly more disease control than oral prednisolone in people with extensive and moderate disease (RR 1.09, 95% CI 1.02 to 1.17), with significantly reduced mortality and adverse events (RR 1.06, 95% CI 1.00 to 1.12).

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment, lack of blinding and more than 20% loss to follow up).

    References

    • Kirtschig G, Middleton P, Bennett C, Murrell DF, Wojnarowska F, Khumalo NP. Interventions for bullous pemphigoid. Cochrane Database Syst Rev 2010;(10):CD002292. [PubMed].

Primary/Secondary Keywords