title: Combined treatment with low-dose methotrexate and initial short-term superpotent topical steroids in bullous pemphigoid: an open, multicentre, retrospective study.
abstract: BACKGROUND
  The interest of long-term superpotent topical steroids (STS) in bullous pemphigoid (BP) has been supported by randomized controlled trials. However, inadequate compliance, poor cutaneous tolerance and nursing difficulties are potential drawbacks. Open-label studies on limited series of patients suggested that low-dose methotrexate (MTX) may be useful, permitting long-term maintenance of a clinical remission obtained by initial, short-term STS.
  
  
  OBJECTIVE
  Open, clinical records-based retrospective analysis of a multicentre series of patients receiving a combined regimen of initial, short-term STS and MTX followed by long-term MTX alone. The primary objective was evaluation of the clinical efficiency of this strategy based on initial clinical remission and subsequent clinical maintenance. The secondary objective was evaluation of the tolerance (type and rating of adverse events) of this combined regimen.
  
  
  METHODS
  Seventy patients with BP (mean age 82·7 years) were included. Treatment consisted of an initial combination of STS and MTX for a mean duration of 12·3 weeks followed by long-term MTX alone for a mean duration of 8·48 months with a mean and median MTX dosage of 10 mg per week.
  
  
  RESULTS
  One hundred per cent of the patients showed an initial, complete clinical remission after a mean time interval of 21·9 days. The overall rate of long-term disease control was 76%, whereas 24% of patients experienced at least one relapse during subsequent treatment with MTX alone. Drug-related adverse effects were mainly haematological and gastrointestinal and resulted in treatment discontinuation in 11 patients (16%). Six patients (9%) died during the follow-up period with one death (1%) most likely to be related to treatment.
  
  
  CONCLUSIONS
  Long-term low-dose MTX combined with short-term STS may result in protracted control of BP in carefully selected patients. These results should prompt randomized controlled trials comparing this treatment with the more usual regimen of long-term STS alone.
authors.affiliation: University of Montpellier I, Department of Dermatology, Hôpital Saint-Eloi, 80 avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. a-du_thanh@chu-montpellier.fr
authors.forename: A
authors.initials: A
authors.lastname: Du-Thanh
authors.forename: S
authors.initials: S
authors.lastname: Merlet
authors.forename: H
authors.initials: H
authors.lastname: Maillard
authors.forename: P
authors.initials: P
authors.lastname: Bernard
authors.forename: P
authors.initials: P
authors.lastname: Joly
authors.forename: E
authors.initials: E
authors.lastname: Estève
authors.forename: M A
authors.initials: MA
authors.lastname: Richard
authors.forename: C
authors.initials: C
authors.lastname: Pauwels
authors.forename: S
authors.initials: S
authors.lastname: Ingen-Housz-Oro
authors.forename: B
authors.initials: B
authors.lastname: Guillot
authors.forename: O
authors.initials: O
authors.lastname: Dereure
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000188:drug therapy*; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D013256:Steroids; D008727:Methotrexate