Effect of early initiation of steroid-sparing drugs in patients with bullous pemphigoid

Inger Johanne Fenne; Guro Askildsen Oftebro; Christian Vestergaard; Anne Sofie Frølunde; Rikke Bech

doi:10.3389/fimmu.2023.1176284

Effect of early initiation of steroid-sparing drugs in patients with bullous pemphigoid

Inger Johanne Fenne^*, Guro Askildsen Oftebro, Christian Vestergaard, Anne Sofie Frølunde, Rikke Bech

^*Corresponding author for this work

Department of Clinical Medicine - The Department of Dermatology and Venereology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

2 Citations (Scopus)

Abstract

Introduction: Bullous pemphigoid (BP) can be treated using systemic and topical glucocorticoids and/or other immunomodulatory agents. However, the long-term use of systemic glucocorticoids causes severe adverse side effects. This study was aimed at investigating whether the early initiation of corticosteroid-sparing therapy (CST) in BP patients results in better outcomes than late or no CST. Method: We retrospectively identified all BP patients referred to the tertiary center, of the Department of Dermatology and Venerology, Aarhus University Hospital, Denmark, from 2015 to 2021. Patients’ demographics, comorbidities, treatment, remission of BP, length of admission, relapse, and 1-year mortality were recorded. All patients who received CST were dichotomised into two groups: initiated with CST <28 or >28 days. The groups were compared using t-tests. Additionally, all patients who received CST were compared with those who received systemic glucocorticoids alone. Our cohort was compared with that of a previous study (2006–2013) performed in our department. In 2015, we revised our BP treatment guidelines to include the early initiation of CST. Results: On comparing the group of patients initiated with CST <28 versus >28 days, we found no significant differences in the complications or mortality between the groups (p = 0.63 and p=0.79, respectively). The <28 days group had a lower rate of relapse (p < 0.05). On comparing data from this study with those from the previous study, conducted before we revised our treatment guideline, we found a reduced initial dose of prednisolone and reduced admission time in this study. No significant differences were found between patients treated with CST and those treated with systemic glucocorticoids alone. Conclusion: The rate of complications and 1-year mortality did not differ significantly between the two subgroups in this study. The relapse rate was lower in the CST <28 days group than in the CST >28 days group. The initial dose of prednisolone and admission time were reduced in this study compared with those in the previous study performed before the implementation of a local treatment guideline recommending the early initiation of CST.

Original language	English
Article number	1176284
Journal	Frontiers in Immunology
Volume	14
Number of pages	9
ISSN	1664-3224
DOIs	https://doi.org/10.3389/fimmu.2023.1176284
Publication status	Published - Jul 2023

Keywords

Glucocorticoids/therapeutic use
Humans
Pemphigoid, Bullous/chemically induced
Prednisolone/adverse effects
Recurrence
Retrospective Studies
Steroids/therapeutic use

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@article{dab786576f0547fd8afdcae167181b3e,

title = "Effect of early initiation of steroid-sparing drugs in patients with bullous pemphigoid",

abstract = "Introduction: Bullous pemphigoid (BP) can be treated using systemic and topical glucocorticoids and/or other immunomodulatory agents. However, the long-term use of systemic glucocorticoids causes severe adverse side effects. This study was aimed at investigating whether the early initiation of corticosteroid-sparing therapy (CST) in BP patients results in better outcomes than late or no CST. Method: We retrospectively identified all BP patients referred to the tertiary center, of the Department of Dermatology and Venerology, Aarhus University Hospital, Denmark, from 2015 to 2021. Patients{\textquoteright} demographics, comorbidities, treatment, remission of BP, length of admission, relapse, and 1-year mortality were recorded. All patients who received CST were dichotomised into two groups: initiated with CST <28 or >28 days. The groups were compared using t-tests. Additionally, all patients who received CST were compared with those who received systemic glucocorticoids alone. Our cohort was compared with that of a previous study (2006–2013) performed in our department. In 2015, we revised our BP treatment guidelines to include the early initiation of CST. Results: On comparing the group of patients initiated with CST <28 versus >28 days, we found no significant differences in the complications or mortality between the groups (p = 0.63 and p=0.79, respectively). The <28 days group had a lower rate of relapse (p < 0.05). On comparing data from this study with those from the previous study, conducted before we revised our treatment guideline, we found a reduced initial dose of prednisolone and reduced admission time in this study. No significant differences were found between patients treated with CST and those treated with systemic glucocorticoids alone. Conclusion: The rate of complications and 1-year mortality did not differ significantly between the two subgroups in this study. The relapse rate was lower in the CST <28 days group than in the CST >28 days group. The initial dose of prednisolone and admission time were reduced in this study compared with those in the previous study performed before the implementation of a local treatment guideline recommending the early initiation of CST.",

keywords = "Glucocorticoids/therapeutic use, Humans, Pemphigoid, Bullous/chemically induced, Prednisolone/adverse effects, Recurrence, Retrospective Studies, Steroids/therapeutic use",

author = "Fenne, \{Inger Johanne\} and \{Askildsen Oftebro\}, Guro and Christian Vestergaard and Fr{\o}lunde, \{Anne Sofie\} and Rikke Bech",

year = "2023",

month = jul,

doi = "10.3389/fimmu.2023.1176284",

language = "English",

volume = "14",

journal = "Frontiers in Immunology",

issn = "1664-3224",

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Effect of early initiation of steroid-sparing drugs in patients with bullous pemphigoid. / Fenne, Inger Johanne; Askildsen Oftebro, Guro; Vestergaard, Christian et al.
In: Frontiers in Immunology, Vol. 14, 1176284, 07.2023.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Effect of early initiation of steroid-sparing drugs in patients with bullous pemphigoid

AU - Fenne, Inger Johanne

AU - Askildsen Oftebro, Guro

AU - Vestergaard, Christian

AU - Frølunde, Anne Sofie

AU - Bech, Rikke

PY - 2023/7

Y1 - 2023/7

N2 - Introduction: Bullous pemphigoid (BP) can be treated using systemic and topical glucocorticoids and/or other immunomodulatory agents. However, the long-term use of systemic glucocorticoids causes severe adverse side effects. This study was aimed at investigating whether the early initiation of corticosteroid-sparing therapy (CST) in BP patients results in better outcomes than late or no CST. Method: We retrospectively identified all BP patients referred to the tertiary center, of the Department of Dermatology and Venerology, Aarhus University Hospital, Denmark, from 2015 to 2021. Patients’ demographics, comorbidities, treatment, remission of BP, length of admission, relapse, and 1-year mortality were recorded. All patients who received CST were dichotomised into two groups: initiated with CST <28 or >28 days. The groups were compared using t-tests. Additionally, all patients who received CST were compared with those who received systemic glucocorticoids alone. Our cohort was compared with that of a previous study (2006–2013) performed in our department. In 2015, we revised our BP treatment guidelines to include the early initiation of CST. Results: On comparing the group of patients initiated with CST <28 versus >28 days, we found no significant differences in the complications or mortality between the groups (p = 0.63 and p=0.79, respectively). The <28 days group had a lower rate of relapse (p < 0.05). On comparing data from this study with those from the previous study, conducted before we revised our treatment guideline, we found a reduced initial dose of prednisolone and reduced admission time in this study. No significant differences were found between patients treated with CST and those treated with systemic glucocorticoids alone. Conclusion: The rate of complications and 1-year mortality did not differ significantly between the two subgroups in this study. The relapse rate was lower in the CST <28 days group than in the CST >28 days group. The initial dose of prednisolone and admission time were reduced in this study compared with those in the previous study performed before the implementation of a local treatment guideline recommending the early initiation of CST.

AB - Introduction: Bullous pemphigoid (BP) can be treated using systemic and topical glucocorticoids and/or other immunomodulatory agents. However, the long-term use of systemic glucocorticoids causes severe adverse side effects. This study was aimed at investigating whether the early initiation of corticosteroid-sparing therapy (CST) in BP patients results in better outcomes than late or no CST. Method: We retrospectively identified all BP patients referred to the tertiary center, of the Department of Dermatology and Venerology, Aarhus University Hospital, Denmark, from 2015 to 2021. Patients’ demographics, comorbidities, treatment, remission of BP, length of admission, relapse, and 1-year mortality were recorded. All patients who received CST were dichotomised into two groups: initiated with CST <28 or >28 days. The groups were compared using t-tests. Additionally, all patients who received CST were compared with those who received systemic glucocorticoids alone. Our cohort was compared with that of a previous study (2006–2013) performed in our department. In 2015, we revised our BP treatment guidelines to include the early initiation of CST. Results: On comparing the group of patients initiated with CST <28 versus >28 days, we found no significant differences in the complications or mortality between the groups (p = 0.63 and p=0.79, respectively). The <28 days group had a lower rate of relapse (p < 0.05). On comparing data from this study with those from the previous study, conducted before we revised our treatment guideline, we found a reduced initial dose of prednisolone and reduced admission time in this study. No significant differences were found between patients treated with CST and those treated with systemic glucocorticoids alone. Conclusion: The rate of complications and 1-year mortality did not differ significantly between the two subgroups in this study. The relapse rate was lower in the CST <28 days group than in the CST >28 days group. The initial dose of prednisolone and admission time were reduced in this study compared with those in the previous study performed before the implementation of a local treatment guideline recommending the early initiation of CST.

KW - Glucocorticoids/therapeutic use

KW - Humans

KW - Pemphigoid, Bullous/chemically induced

KW - Prednisolone/adverse effects

KW - Recurrence

KW - Retrospective Studies

KW - Steroids/therapeutic use

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U2 - 10.3389/fimmu.2023.1176284

DO - 10.3389/fimmu.2023.1176284

M3 - Journal article

C2 - 37483611

SN - 1664-3224

VL - 14

JO - Frontiers in Immunology

JF - Frontiers in Immunology

M1 - 1176284

ER -

Effect of early initiation of steroid-sparing drugs in patients with bullous pemphigoid

Abstract

Keywords

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