Relationship Between Adverse Pregnancy Outcomes and Serum Anti-BP180 IgG Antibody Levels in Patients With Pemphigoid Gestationis

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• This multicenter retrospective cohort study investigated the prognostic utility of ELISA measurement of anti-BP180 IgG antibodies in patients with pemphigoid gestationis. Higher anti-BP180 values were noted in patients with blisters. Anti-BP180 values higher than 150 IU were associated with an increased risk of adverse pregnancy outcomes.
• The presence of clinical blisters and anti-BP180 antibody values higher than 150 IU are risk factors of all-cause adverse pregnancy outcomes in patients with pemphigoid gestationis.

–  Joshua R. Ortego, MD

Written by

 

 

Kelly H. Tyler MD, FACOG, FAAD

Considering the rarity of the disease, the authors of this study present a fairly large, multicenter retrospective analysis looking at anti-BP180 antibody ELISA values as a predictor of adverse pregnancy outcomes in patients with pemphigoid gestationis (PG). In the past, the only predictors we had were earlier onset of the disease and presence of blisters. This study shows convincing evidence that anti-BP180 ELISA values over 150 IU are predictive of patients who have a higher risk of intrauterine growth restriction (IUGR). In addition, they found that the combination of anti-BP180 antibody ELISA values over 150 IU and the presence of blisters translated to a twofold increased risk of all-cause adverse pregnancy outcomes, including IUGR, prematurity, and small for gestational age. Given these data, clinicians should use both clinical features and anti-BP180 antibody ELISA values drawn at the time of diagnosis to delineate which patients with PG are at higher risk of adverse pregnancy outcomes and thus require closer surveillance by our colleagues in maternal–fetal medicine.

Abstract

BACKGROUND

Adverse pregnancy outcomes (APO) occur in 35% of patients with pemphigoid gestationis (PG). No biological predictor of APO has been established yet.

OBJECTIVES

To assess a potential relationship between the occurrence of APO and the serum value of anti-BP180 antibodies at the time of PG diagnosis.

METHODS

Multicenter retrospective study conducted from January 2009 to December 2019 in 35 secondary and tertiary care centers.

INCLUSION CRITERIA

i) diagnosis of PG according to clinical, histological and immunological criteria, ii) ELISA measurement of anti-BP180 IgG antibodies determined at the time of PG diagnosis with the same commercial kit, iii) obstetrical data available.

RESULTS

Of the 95 patients with PG included, 42 had one or more APO which mainly corresponded to preterm birth (n=26), intra uterine growth restriction (IUGR) (n=18) and small weight for gestational age at birth (n=16). From a ROC curve we identified a threshold of 150 IU ELISA value as the most discriminating to differentiate between patients with or without IUGR, with 78% sensitivity, 55% specificity, 30% positive and 91% negative predictive value. The threshold >150IU was confirmed using a cross validation based on bootstrap resampling which showed that the median threshold was 159 IU. Upon adjusting for oral corticosteroid intake and main clinical predictors of APO, an ELISA value of > 150 IU was associated with the occurrence of IUGR (OR=5.11; 95% CI: 1.48-22.30; p= 0.016) but not with any other APO. The combination of blisters and ELISA values higher than 150 IU lead to a 2.4-fold higher risk of all-cause APO (OR:10.90; 95% CI:2.33 - 82.3) relative to patients with blisters but lower values of anti-BP180 antibodies (OR of 4.54; 95% CI 0.92-34.2).

CONCLUSION

These findings suggest that anti-BP180 antibody ELISA value in combination with clinical markers is helpful in managing the risk of APO, in particular IUGR, in patients with PG.

Journal of the European Academy of Dermatology and Venereology: JEADV

Anti-BP180 IgG antibody ELISA values correlate with adverse pregnancy outcomes in pemphigoid gestationis

J Eur Acad Dermatol Venereol 2023 Feb 18;[EPub Ahead of Print], N Cordel, J Flament, F Jouen, V Seta, E Tancrède-Bohin, C Picard Dahan, MP Konstantinou, O Dereure, G Quéreux, C Prost, C Bedane, S Debarbieux, JP Lacour, A Dompmartin, E Wierzbicka-Hainaut, I Bourgault Villada, S Ingen Housz Oro, P Vabres, MA Richard, E Delaporte, A Pham-Ledard, MT Leccia, N Litrowski, C Michel, B Lagrange, M D'Incan, C Abasq, S Duvert-Lehembre, A Dupuy, I Alcaraz, AL Breton-Guitarian, F Lombart, E Estève, L Machet, P Del Giudice, M Fenot, T Belmondo, F Morin, O Guérin, J Benichou, B Tressières, P Joly 

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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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