Topical corticosteroid therapy effective for bullous pemphigoid

NEW YORK (Reuters Health) – For severe extensive bullous pemphigoid, topical corticosteroid therapy is superior to oral corticosteroid therapy, French researchers report in January 31 issue of The New England Journal of Medicine.

Dr. Pascal Joly from the University of Rouen, and colleagues randomly assigned 341 patients, who were approximately 80 years of age or older, with bullous pemphigoid to topical clobetasol propionate cream, 40 g per day, or oral prednisone, 0.5 mg/kg per day for those with moderate disease, or 1 mg/kg per day for those with severe disease. "The primary endpoint was overall survival," they explain.

For the 188 patients with extensive bullous pemphigoid, clobetasol propionate cream was superior to oral prednisone, the researchers report. At 1 year, the survival rate was 76% for patients receiving topical corticosteroid therapy compared with 58% for patients receiving oral corticosteroid therapy.

At 3 weeks, bullous pemphigoid was controlled in 92 of 93 patients on topical corticosteroid therapy, compared with 86 of 95 patients receiving oral corticosteroid therapy (p = 0.02), Dr. Joly's team found.

There were severe complications in 27 of 93 patients receiving clobetasol propionate cream and in 51 of 95 patients receiving oral prednisone (p = 0.006). For the 153 patients with moderate disease, the French investigators noted no significant difference between the two treatment regimens in "overall survival, the rate of control at 3 weeks, or the incidence of severe complications."

Dr. Joly and colleagues conclude the findings demonstrate the "superiority of an alternative treatment regimen over oral corticosteroids in the treatment of extensive bullous pemphigoid, in terms of both control of disease and survival. Our results suggest that topical corticosteroids should be considered the standard treatment for patients with extensive bullous pemphigoid."

"Joly et al. have provided important information that can improve the outcome in elderly patients with bullous pemphigoid," Dr. Robert S. Stern from Beth Israel Deaconess Medical Center in Boston, comments in a journal editorial.

However, he adds, "the combined efforts of patients, their families and healthcare providers are needed to translate these findings into routine clinical practice."
N Engl J Med 2002;346:321-327,364-367.

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