Plasma exchange in bullous pemphigoid.

Area of Science:

• Dermatology
• Immunology
• Nephrology

Background:

• Pemphigoid is an autoimmune blistering disease.
• Corticosteroids are the mainstay treatment but have significant side effects.
• Alternative or adjunctive therapies are needed to reduce corticosteroid burden.

Purpose of the Study:

• To evaluate the efficacy of plasma exchange as an adjunctive therapy in pemphigoid.
• To determine if plasma exchange can reduce the required dose of corticosteroids.

Main Methods:

• A multicentre randomized study involving 41 patients with pemphigoid.
• Patients received daily oral prednisolone, with weekly dose adjustments.
• 24 patients received plasma exchange (8 large-volume exchanges over 4 weeks) in addition to prednisolone, while 17 received prednisolone only.

Main Results:

• Plasma exchange was effective in 13 of 22 patients initially, compared to none of 15 patients on prednisolone alone.
• Mean daily prednisolone dose was 0.52 mg/kg in the plasma exchange group versus 0.97 mg/kg in the control group.
• Mean cumulative prednisolone dose was substantially lower in the plasma exchange group (1240 mg) compared to the control group (2770 mg).

Conclusions:

• Plasma exchange allows for a substantial reduction in corticosteroid requirements for pemphigoid patients.
• This corticosteroid-sparing effect was observed regardless of baseline anti-basement membrane antibody levels.
• Plasma exchange is a viable adjunctive therapy for managing pemphigoid, potentially mitigating long-term corticosteroid toxicity.