Bullous pemphigoid is a rare blistering disease. And because it is a rare disease, treatment generally involves off label treatments based on limited data. Current guidelines indicate that patients should generally receive corticosteroids first and others treatment options second. A new study in Lancet
indicates that an antibiotic may be just as effective as corticosteroids for treating bullous pemphigoid, and with less side effects.
Williams et al performed a non-inferiority, multicenter, parallel-group randomized controlled trial of adults with bullous pemphigoid (N=132) randomly assigned to the antibiotic doxycycline (200 mg/day) or the corticosteroid prednisolone (0.5 mg/kg/day) and stratified by baseline severity (3–9, 10–30, and >30 blisters for mild, moderate, and severe disease, respectively). The non-inferiority primary effectiveness outcome was the proportion of participants with 3 or fewer blisters at 6 weeks. primary safety outcome was the proportion with severe, life-threatening, or fatal (grade 3–5) treatment-related adverse events by 52 weeks.
After 6 weeks, 74% (83/112) of patients given doxycycline had 3 or fewer blisters compared with 91% (92/101) of those given prednisolone. Regarding safety, severe, life-threatening, and fatal events at 52 weeks were reported in 18% (22 of 121) of those given doxycycline and 36% (41 of 113) of those given prednisolone. The differences in efficacy were not significantly different whereas they were for the safety profile, (P = .001).
The authors concluded that beginning treatment with the antibiotic doxycycline is just as effective as the oral steroid prednisolone in controlling short-term blisters in bullous pemphigoid and the antibiotic has significantly fewer side effects in the long term.
Williams HC, Wojnarowski F, Kirtschig G, et al. Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial. Lancet.
Published Online March 6, 2017 http://dx.doi.org/10.1016/ S0140-6736(17)30560-3