title: Anti-BP180 NC16A IgG Titres as an Indicator of Disease Activity and Outcome in Asian Patients with Bullous Pemphigoid.
abstract: BACKGROUND
  Anti-BP180 IgG titres were observed to parallel disease activity in case series of bullous pemphigoid (BP). This study aimed to examine whether anti-BP180 titres are an indicator of disease severity, clinical course and outcome in Asian patients with BP.
  
  
  METHODS
  This was a prospective observational study conducted between March 2005 and March 2008 in the Immunodermatology Clinic at the National Skin Centre, Singapore. Disease activity and anti-BP180 IgG titres were measured 4-weekly for 12 weeks and during disease flares and clinical remission. Associations between anti-BP180 titres and disease activity, disease flare, clinical remission and cumulative prednisolone dose were examined.
  
  
  RESULTS
  Thirty-four patients with newly diagnosed BP were recruited. Median follow-up duration was 3 years. Notable correlations between disease activity and anti-BP180 titres were at baseline (r = 0.51, P = 0.002), and disease flare (r = 0.85, P <0.001). Lower titres at Week 12 were associated with greater likelihood of clinical remission (P = 0.036). Post hoc, patients with anti-BP180 titres above 87.5 U/mL at time of diagnosis who reached remission within 2 years of diagnosis received significantly higher cumulative doses (mg/kg) of prednisolone (median, 72.8; range, 56.5 to 127.1) than those with titres <87.5 U/mL (median, 44.6; range, 32.5 to 80.8); P = 0.025).
  
  
  CONCLUSIONS
  Anti-BP180 titres may be a useful indicator of disease activity at time of diagnosis and at disease flare. Lower titres at Week 12 may predict greater likelihood of clinical remission. Titres above 87.5 U/mL at time of diagnosis may suggest the need for higher cumulative doses of prednisolone to achieve remission within 2 years.
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Sophie C S
authors.initials: SC
authors.lastname: Cai
authors.forename: Yen Loo
authors.initials: YL
authors.lastname: Lim
authors.forename: Wenyun
authors.initials: W
authors.lastname: Li
authors.forename: John Carson
authors.initials: JC
authors.lastname: Allen
authors.forename: Sze Hon
authors.initials: SH
authors.lastname: Chua
authors.forename: Suat Hoon
authors.initials: SH
authors.lastname: Tan
authors.forename: Mark B Y
authors.initials: MB
authors.lastname: Tang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D044466:Asian People; D001323:Autoantibodies / Q000097:blood*; D001324:Autoantigens / Q000097:blood*; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D024041:Non-Fibrillar Collagens / Q000097:blood*; D017063:Outcome Assessment, Health Care; D010391:Pemphigoid, Bullous / Q000175:diagnosis* / Q000208:ethnology / Q000276:immunology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012846:Singapore; D000097805:Collagen Type XVII
chemical_list: D000888:Antibodies, Anti-Idiotypic; D001323:Autoantibodies; D001324:Autoantigens; D024041:Non-Fibrillar Collagens; D000097805:Collagen Type XVII; C048844:anti-IgG