Plasmapheresis as a steroid saving procedure in bullous pemphigoid.
BACKGROUND
Bullous pemphigoid is an immunobullous disease affecting predominantly older patients. In severe cases, high-dose corticosteroids and/or other immunosuppressants are often needed long term to control the disease. These can be associated with serious side-effects in this patient population. Objective To evaluate the benefit of plasmapheresis as a steroid saving agent in a cohort of 10 patients.


RESULTS
Plasmapheresis was effective as a steroid saving therapy. All patients went into remission with a lower daily dosage of oral prednisone at 3 and 6 months postplasmapheresis. Two patients had side-effects from therapy that, while significant, did not interfere with long-term improvement in their disease. Eight patients had circulating immunoglobulin G (IgG) antibodies reactive with bullous pemphigoid antigen 1, and three of these had circulating antibodies reactive with bullous pemphigoid antigen 2 on Western immunoblot.


CONCLUSIONS
Plasmapheresis was an effective steroid sparing therapy in these patients. Due to its high cost and potential morbidity, plasmapheresis should not be recommended as routine therapy for bullous pemphigoid, but it is a useful adjunct in resistant cases.
Egan
C A
CA
Medicine Service, Section of Dermatology, Salt Lake City Veterans Affairs Medical Center and Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Meadows
K P
KP
Zone
J J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001324:Autoantigens / Q000276:immunology; D001379:Azathioprine / Q000627:therapeutic use; D002352:Carrier Proteins; D003094:Collagen / Q000276:immunology; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003598:Cytoskeletal Proteins; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D000071821:Dystonin; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009419:Nerve Tissue Proteins; D024041:Non-Fibrillar Collagens; D010391:Pemphigoid, Bullous / Q000473:pathology / Q000628:therapy*; D010956:Plasmapheresis; D011241:Prednisone / Q000627:therapeutic use*; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D000097805:Collagen Type XVII
D000893:Anti-Inflammatory Agents; D001324:Autoantigens; D001379:Azathioprine; D002352:Carrier Proteins; D003094:Collagen; D003520:Cyclophosphamide; D003598:Cytoskeletal Proteins; D000071821:Dystonin; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D009419:Nerve Tissue Proteins; D024041:Non-Fibrillar Collagens; D011241:Prednisone; D000097805:Collagen Type XVII; C486268:DST protein, human