Oral–topical treatment regimen an attractive alternative to prednisone in bullous pemphigoid
A treatment regimen containing oral tetracycline and nicotinamide plus topical clobetasol appears to be effective in the treatment of bullous pemphigoid (BP), yielding better survival rates compared with prednisone, according to a study.
The 3-year retrospective study included 106 patients with newly diagnosed BP (mean age 78 years; 64.4 percent female), among whom 59 received tetracycline 1.5 g/daily, nicotinamide 1.2 g/daily and 0.05 percent lesionally administered clobetasol cream (TNC arm), while 47 received prednisone 0.5 mg/kg daily.
Both patient groups achieved median time to disease control after 7 days. The proportion of patients who achieved disease control at week 4 was 93.2 percent in the TNC arm vs 89.1 percent in the prednisone arm.
The median period between complete remission and relapse was 60 days in the TNC group and 90 days in the prednisone group (p=0.84). Within 1 year, significantly more patients in the prednisolone vs TNC group had at least one relapse within 1 year (50 percent vs 32.1 percent; p=0.09).
The 1-year survival was 83 percent in the TNC group and 65.9 percent in the prednisone group (p=0.04), while the corresponding 3-year survival was 71.2 percent and 48 percent (p=0.019).
The present data show that combined treatment with tetracycline, nicotinamide and lesionally administered clobetasol may improve survival rates compared with prednisone in patients with BP, researchers said. Thus, it would be reasonable to initiate this regimen in age-advanced patients with comorbidities and movement difficulties.