Treatment of recalcitrant bullous pemphigoid (BP) with a novel protocol: A retrospective study with a 6-year follow-up - 18/04/17
, Shawn Shetty, MD a, Srini Kaveri, DVM, PhD b, Zachary S. Spigelman, MD cAbstract |
Background |
Bullous pemphigoid is an autoimmune blistering skin disease that predominantly affects the elderly. Conventional therapy using high-dose systemic corticosteroids and immunosuppressive agents can be ineffective in some patients and produce adverse events and relapses. Hence, alternate therapies are required.
Objective |
The clinical outcomes of patients with extensive, recalcitrant bullous pemphigoid treated with a combination therapy of rituximab (RTX) and intravenous immunoglobulin were evaluated.
Methods |
In this retrospective study, 12 patients (mean age of 68.25 years) unresponsive to previous conventional immunosuppressive therapy, intravenous immunoglobulin, and/or RTX were treated with this combination therapy.
Results |
Complete clinical resolution occurred in a mean of 4.6 months and previous systemic therapy was discontinued in 6.2 months. Two patients had a recurrence posttherapy and responded to additional RTX infusions. The remaining 10 patients had no recurrences. Patients were followed up for a mean of 73.8 months after discontinuation of all systemic therapy. All have remained in remission without adverse events for 6 years.
Limitations |
This was a retrospective study with a small sample size.
Conclusion |
The combination of RTX and intravenous immunoglobulin produced a sustained clinical remission without adverse events, infections, and hospitalizations. This specific combination protocol offers a promising therapy for patients with recalcitrant bullous pemphigoid.
Le texte complet de cet article est disponible en PDF.Key words : bullous pemphigoid, clinical response, combination therapy, conventional therapy, death, infection, intravenous immunoglobulin, recalcitrant, remission, rituximab
Abbreviations used : BP, CS, DIF, ELISA, IIF, ISA, IVIg, RTX
Plan
| Funding sources: None. |
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| Conflicts of interest: None declared. |
Vol 74 - N° 4
P. 700 - avril 2016 Retour au numéro
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