Impact of Immunological Tests to Predict Relapse of Bullous Pemphigoid After Treatment Cessation Journal of the American Academy of Dermatology

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• In this retrospective study, the authors evaluated the relapse rate of bullous pemphigoid after complete clinical remission post-treatment cessation (TC). The TC decision was made based on results of immunological tests (ie, positive or negative) or was made without tests. Of 238 patients, 49% underwent immunological testing at the end of treatment; 82% of whom tested negative. At 6 months after TC, 20.3% of patients experienced relapse of their disease (P = .80), and the disease relapse rate did not differ among the three TC groups.

• TC based on immunological test results is not associated with lower relapse rates. It is reasonable to use complete remission as a guide for the decision to stop treatment in bullous pemphigoid.

–  Katherine M. Stiff, MD

Abstract

BACKGROUND

A high level of anti-BP180 antibodies on ELISA and a persistent positive direct immunofluorescence at the end of treatment (immunological tests, ITs) are predictors of relapse after treatment cessation (TC) in patients with bullous pemphigoid.

OBJECTIVE

To evaluate the real-life impact of the immunological-based decision of TC on the 3 and 6-month relapse rate after TC in bullous pemphigoid.

METHODS

Retrospective multicentric study included patients followed almost 6 months after TC. Patients were classified according to whether the TC decision was in accordance with the results of ITs performed during the 3 months before TC, despite the results of ITs or without ITs performed.

RESULTS

We included 238 patients. Three months after TC, 36 patients showed relapse: 14/95 of patients with TC in accordance with IT results (14.7%), 5/21 with TC despite ITs (23.8%) and 17/122 with TC without ITs (13.9%, p=0.5). Six months after TC, the relapse rate was 18.9%, 28.6%, and 18.9% (p=0.56), respectively, in the 3 groups.

LIMITATIONS

The retrospective design and the limited follow-up.

CONCLUSION

In real-life practice, in bullous pemphigoid, 3 and 6-month relapse rate was not significantly reduced with TC decision based on results of ITs as compared with a classical clinical-based decision.

Journal of the American Academy of Dermatology

Real-life impact of the immunological tests to predict relapse after treatment cessation in patients with bullous pemphigoid: a French multicenter retrospective study

J Am Acad Dermatol 2022 Jan 25;[EPub Ahead of Print], G Battesti, C Garcia, M Viguier, V Marchal, M Castel, P Joly, AP Ledard, MP Konstantinou, V Seta, N Cordel, S Duvert-Lehembre, E Tancrède-Bohin, T Belmondo, S Ingen-Housz-Oro, M d'Incan 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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