Adjuvant treatment of recalcitrant bullous pemphigoid with immunoadsorption.
Elimination of pathogenic autoantibodies by immunoadsorption (IA) has been described as an effective adjuvant treatment in severe bullous autoimmune diseases, especially in pemphigus. There is much less experience in the treatment of bullous pemphigoid (BP). BP was diagnosed in a 62-year-old Caucasian woman presenting a pruritic rash with multiple tense blisters. Standard treatments with topical and oral corticosteroids, steroid-sparing agents including dapsone, azathioprine, mycophenolate mofetil (MMF) and intravenous immunoglobulins were ineffective or had to be discontinued due to adverse events. An immediate clinical response could be achieved by two treatment cycles of adjuvant protein A immunoadsorption (PA-IA) in addition to continued treatment with MMF (2 g/day) and prednisolone (1 mg/kg/day). Tolerance was excellent. Clinical improvement remained stable after discontinuation of IA and went along with sustained reduction of circulating autoantibodies. Our data demonstrate that PA-IA might be a safe and effective adjuvant treatment in severe and recalcitrant BP.
Department of Dermatology, Venereology and Allergology, University of Würzburg, Würzburg, Germany.
P A
PA
Müller
E B
EB
Bröcker
E
E
Klinker
J
J
Stoevesandt
S
S
Benoit
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D001324:Autoantigens / Q000276:immunology; D002352:Carrier Proteins; D003598:Cytoskeletal Proteins; D003879:Dermatologic Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000071821:Dystonin; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques; D008562:Membrane Glycoproteins / Q000276:immunology; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D009419:Nerve Tissue Proteins; D024041:Non-Fibrillar Collagens / Q000276:immunology; D010391:Pemphigoid, Bullous / Q000097:blood / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D011239:Prednisolone / Q000627:therapeutic use; D012720:Severity of Illness Index; D016060:Sorption Detoxification / Q000379:methods*; D013205:Staphylococcal Protein A / Q000276:immunology; D016896:Treatment Outcome; D000097805:Collagen Type XVII
D000276:Adjuvants, Immunologic; D001323:Autoantibodies; D001324:Autoantigens; D002352:Carrier Proteins; D003598:Cytoskeletal Proteins; D003879:Dermatologic Agents; D000071821:Dystonin; D008562:Membrane Glycoproteins; D009173:Mycophenolic Acid; D009419:Nerve Tissue Proteins; D024041:Non-Fibrillar Collagens; D011239:Prednisolone; D013205:Staphylococcal Protein A; D000097805:Collagen Type XVII; C486268:DST protein, human