title: Risk factors for relapse in patients with bullous pemphigoid in clinical remission: a multicenter, prospective, cohort study.
abstract: OBJECTIVE
  To identify prognostic factors for relapse in the first year after cessation of therapy in bullous pemphigoid (BP).
  
  
  METHODS
  Prospective, multicenter, cohort study (January 1, 2000, through December 31, 2006).
  
  
  METHODS
  Fifteen French dermatology departments. Patients Patients with BP in remission under low doses of topical or systemic corticosteroids. Interventions Cessation of corticosteroid treatment (day 0) followed by a systematic clinical and immunologic follow-up.
  
  
  METHODS
  The end point was clinical relapse within the first year after cessation of therapy. Associations of clinical, biological, and immunologic (including direct immunofluorescence, serum anti-basement membrane zone autoantibodies, and serum BP180 autoantibodies by enzyme-linked immunosorbent assay [ELISA] on day 0) variables with clinical relapse were assessed by means of univariate and multivariate analyses.
  
  
  RESULTS
  On day 0, 30 of 114 patients (26.3%) still had a positive result of direct immunofluorescence, 63 of 112 (56.3%) had circulating anti-basement membrane zone autoantibodies, and 34 of 57 (60%) had anti-BP180 antibodies by ELISA. At month 12, 22 patients were dead (n = 11) or lost to follow-up (n = 11), 51 were in remission, and 45 had had relapses (mean interval to relapse, 3.2 months). Factors predictive of relapse within 12 months after cessation of therapy were a positive result of direct immunofluorescence microscopy (P = .02), a greater age (P = .01), and high-titer ELISA scores (P = .02) on day 0. In multivariate analysis, the only factor independently predictive of relapse was a high-titer ELISA score on day 0 (odds ratio, 11.00; 95% confidence interval, 1.29-93.76).
  
  
  CONCLUSIONS
  High-titer anti-BP180 ELISA score and, to a lesser degree, a positive direct immunofluorescence finding are good indicators of further relapse of BP. At least 1 of these tests should be performed before therapy is discontinued.
authors.affiliation: Service de Dermatologie, Hôpital Robert Debré, avenue du général Koenig, 51092 Reims CEDEX, France. pbernard@chu-reims.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Bernard
authors.forename: Ziad
authors.initials: Z
authors.lastname: Reguiai
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Tancrède-Bohin
authors.forename: Nadege
authors.initials: N
authors.lastname: Cordel
authors.forename: Patrice
authors.initials: P
authors.lastname: Plantin
authors.forename: Christine
authors.initials: C
authors.lastname: Pauwels
authors.forename: Loïc
authors.initials: L
authors.lastname: Vaillant
authors.forename: Florent
authors.initials: F
authors.lastname: Grange
authors.forename: Marie-Aleth
authors.initials: MA
authors.lastname: Richard-Lallemand
authors.forename: Bruno
authors.initials: B
authors.lastname: Sassolas
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Roujeau
authors.forename: Catherine
authors.initials: C
authors.lastname: Lok
authors.forename: Catherine
authors.initials: C
authors.lastname: Picard-Dahan
authors.forename: Olivier
authors.initials: O
authors.lastname: Chosidow
authors.forename: Fabien
authors.initials: F
authors.lastname: Vitry
authors.forename: Pascal
authors.initials: P
authors.lastname: Joly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D001324:Autoantigens / Q000097:blood / Q000276:immunology*; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D024041:Non-Fibrillar Collagens / Q000097:blood / Q000276:immunology*; D016017:Odds Ratio; D010391:Pemphigoid, Bullous / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D000097805:Collagen Type XVII
chemical_list: D001323:Autoantibodies; D001324:Autoantigens; D005938:Glucocorticoids; D024041:Non-Fibrillar Collagens; D000097805:Collagen Type XVII