Original Article
Efficacy and safety of azathioprine and dapsone as an adjuvant in the treatment of bullous pemphigoid

https://doi.org/10.1016/j.aller.2010.12.009Get rights and content

Summary

Background

Bullous pemphigoid is a chronic, blistering and autoimmune disease, common in old age. The treatment usually includes systemic steroids, however, these cause high morbidity rates, and then different products that function as adjuvants have been tried. At present, there are no studies to determine which adjuvant offers a better efficacy and safety profile.

Methods

We performed a retrospective study which included the records of patients with bullous pemphigoid, treated either with azathioprine or dapsone. We evaluated the time to achieve complete remission, the time to inhibit disease progression, and the control of pruritus.

Results

Fifteen records of patients were selected, eight (53%) treated with azathioprine and seven (47%) with dapsone. Complete remission was achieved at week six in both groups. We found no difference in the inhibition of disease progression (p = 0.083). Pruritus was controlled at four weeks of treatment in both treatments.

Conclusions

Both products are effective as adjuvant in the treatment of bullous pemphigoid, with an acceptable safety profile.

Introduction

Bullous pemphigoid (BP) is an autoimmune disease, characterised by subepidermal blistering. The disease usually presents in elderly patients. Bullous pemphigoid rarely affects the mucous membranes and is associated with substantial morbidity. The disease express autoantibodies directed against cutaneous autoantigens, BP230 and BP180, called antigen 1 and 2 of BP respectively, both located in the hemidesmosome and anchoring filaments.1

The treatment of choice are systemic steroids, like prednisone, at the dose of 0.5–0.75 mg/kg/day,1, 2 however, class I topical steroids are preferred in localised forms.3 Systemic steroids improve patients’ survival in BP, but also increase the risk of death and life-threatening adverse events.4 Other immunosupresant drugs, called adjuvants, have been widely used to treat autoimmune diseases (e.g. Pemphigus vulgaris) to achieve a corticosteroid-sparing effect.3, 4 The most frequently used agent is azathioprine, while dapsone is another effective option. Therefore we decided to conduct a retrospective study to evaluate the effectiveness and safety of azathioprine and dapsone in BP.

Section snippets

Material and methods

We selected the records of the patients with BP, diagnosed by clinical (lesions suggestive of BP), histological (subepidermal blister) and/or immunological criteria (linear deposition of IgG and/or C3 at the dermoepidermal junction), admitted at the Department of Dermatology, General Hospital of Mexico, in the period from January 2006 to January 2010. All patients had received prednisone 0.5–0.75 mg/kg/day in combination with either azathioprine (group 1, 2–3 mg/kg/day) or dapsone (group 2, 100 

Statistical analysis

We perform a Wilcoxon test to evaluate the primary outcome measure. Dichotomous and ordered categorical data were analysed with the Fisher exact and the Mann Whitney test respectively. The analysis was conducted using the statistical program SPSS (version 12 for Windows, Chicago, Ill., USA).

Baseline

We selected 15 records of patients with BP, eight (53%) with azathioprine and seven (47%) with dapsone (demographic and clinical data of the sample are presented in Table 1). All patients represented newly diagnosis BP cases. The mean age was 65.36 ± 6.69 years. The approximate body surface affected (BSA) was 26.2 ± 4.85% (the calculation was made based on the rule of nine). In group 1 (azathioprine), the mean age was 66.4 ± 7.83 years, with BSA of 24.65 ± 6.13%, while in the dapsone group, the average

Discussion

Bullous pemphigoid is a chronic, autoimmune, bullous disease, most commonly seen in the elderly.5, 6 The incidence does not vary among male and female.7 Bullous pemphigoid represents one of the most common subepidermal autoimmune blistering diseases. Patients generally exhibit disseminated lesions consisting in tense blisters, variable in number and size, accompanied by moderate to severe pruritus, often with erythematous or urticarial lesions that may precede the blister, and subsequently

Conflicts of interest

The authors have no conflict of interest to declare.

References (12)

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