Methylprednisolone Plus Low-Dose Methotrexate for Bullous Pemphigoid—A Single Center Retrospective Analysis
Monomodal systemic glucocorticoids remain the mainstay of treatment for bullous pemphigoid (BP). In this retrospective, single-arm study, we evaluated the feasibility (efficacy and tolerability) of the combination of methylprednisolone and low-dose (up to 12.5 mg/week) methotrexate (MP + MTX) for BP...
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MDPI AG
2022-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/11/3193 |
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| author | Agoritsa Gravani Georgios Gaitanis Panagiota Spyridonos Ioannis Alexis Stelios Tigas Ioannis D. Bassukas |
| author_facet | Agoritsa Gravani Georgios Gaitanis Panagiota Spyridonos Ioannis Alexis Stelios Tigas Ioannis D. Bassukas |
| author_sort | Agoritsa Gravani |
| collection | DOAJ |
| description | Monomodal systemic glucocorticoids remain the mainstay of treatment for bullous pemphigoid (BP). In this retrospective, single-arm study, we evaluated the feasibility (efficacy and tolerability) of the combination of methylprednisolone and low-dose (up to 12.5 mg/week) methotrexate (MP + MTX) for BP. At week 12, 53/55 (96.4%) patients initiated on MP + MTX during a five-year period (potential follow up time: ≥4 years) remained on treatment. At this time-point, BP remission was achieved in all compliant patients (including <i>n</i> = 24 cases of dipeptidyl peptidase-4 inhibitors-associated BP; 12-week remission rate: 100% [95% CI: 91.9–100.0%]; mean time to remission: 29.5 days, SEM: 2.3 days) at a mean cumulative MP dose to disease control of 678.4 mg (SEM = 49.4 mg). Eight patients relapsed during follow up (10.81 [95% CI: 5.16–21.72] relapses/100 person years, py), and seven manifested a severe adverse event (6.80 [95% CI: 3.00–14.28] severe adverse events/100 py); however, 73.4% (±7.9%) had suffered neither a relapse nor a SAE at the three-years follow up. Continuing low dose MP intake (≤8 mg/day) beyond week 12 in combination with MTX minimized the risk of a feasibility limiting event (<i>p</i> = 0.013). Conclusively, the combination of methylprednisolone with methotrexate is a promising, safe, and efficient modality for BP patients, which enables rapid glucocorticoid tapering. |
| first_indexed | 2024-03-10T01:10:23Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T01:10:23Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-81503f5259384d8496903fedba4f39412023-11-23T14:18:20ZengMDPI AGJournal of Clinical Medicine2077-03832022-06-011111319310.3390/jcm11113193Methylprednisolone Plus Low-Dose Methotrexate for Bullous Pemphigoid—A Single Center Retrospective AnalysisAgoritsa Gravani0Georgios Gaitanis1Panagiota Spyridonos2Ioannis Alexis3Stelios Tigas4Ioannis D. Bassukas5Department of Dermatology, University General Hospital of Ioannina, 45500 Ioannina, GreeceDepartment of Dermatology, University General Hospital of Ioannina, 45500 Ioannina, GreeceDepartment of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, GreeceDepartment of Dermatology, University General Hospital of Ioannina, 45500 Ioannina, GreeceDepartment of Endocrinology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, GreeceDepartment of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, GreeceMonomodal systemic glucocorticoids remain the mainstay of treatment for bullous pemphigoid (BP). In this retrospective, single-arm study, we evaluated the feasibility (efficacy and tolerability) of the combination of methylprednisolone and low-dose (up to 12.5 mg/week) methotrexate (MP + MTX) for BP. At week 12, 53/55 (96.4%) patients initiated on MP + MTX during a five-year period (potential follow up time: ≥4 years) remained on treatment. At this time-point, BP remission was achieved in all compliant patients (including <i>n</i> = 24 cases of dipeptidyl peptidase-4 inhibitors-associated BP; 12-week remission rate: 100% [95% CI: 91.9–100.0%]; mean time to remission: 29.5 days, SEM: 2.3 days) at a mean cumulative MP dose to disease control of 678.4 mg (SEM = 49.4 mg). Eight patients relapsed during follow up (10.81 [95% CI: 5.16–21.72] relapses/100 person years, py), and seven manifested a severe adverse event (6.80 [95% CI: 3.00–14.28] severe adverse events/100 py); however, 73.4% (±7.9%) had suffered neither a relapse nor a SAE at the three-years follow up. Continuing low dose MP intake (≤8 mg/day) beyond week 12 in combination with MTX minimized the risk of a feasibility limiting event (<i>p</i> = 0.013). Conclusively, the combination of methylprednisolone with methotrexate is a promising, safe, and efficient modality for BP patients, which enables rapid glucocorticoid tapering.https://www.mdpi.com/2077-0383/11/11/3193bullous pemphigoidmethotrexateglucocorticoid sparingmethylprednisolonecombination treatmentdipeptidyl peptidase-4 inhibitors |
| spellingShingle | Agoritsa Gravani Georgios Gaitanis Panagiota Spyridonos Ioannis Alexis Stelios Tigas Ioannis D. Bassukas Methylprednisolone Plus Low-Dose Methotrexate for Bullous Pemphigoid—A Single Center Retrospective Analysis Journal of Clinical Medicine bullous pemphigoid methotrexate glucocorticoid sparing methylprednisolone combination treatment dipeptidyl peptidase-4 inhibitors |
| title | Methylprednisolone Plus Low-Dose Methotrexate for Bullous Pemphigoid—A Single Center Retrospective Analysis |
| title_full | Methylprednisolone Plus Low-Dose Methotrexate for Bullous Pemphigoid—A Single Center Retrospective Analysis |
| title_fullStr | Methylprednisolone Plus Low-Dose Methotrexate for Bullous Pemphigoid—A Single Center Retrospective Analysis |
| title_full_unstemmed | Methylprednisolone Plus Low-Dose Methotrexate for Bullous Pemphigoid—A Single Center Retrospective Analysis |
| title_short | Methylprednisolone Plus Low-Dose Methotrexate for Bullous Pemphigoid—A Single Center Retrospective Analysis |
| title_sort | methylprednisolone plus low dose methotrexate for bullous pemphigoid a single center retrospective analysis |
| topic | bullous pemphigoid methotrexate glucocorticoid sparing methylprednisolone combination treatment dipeptidyl peptidase-4 inhibitors |
| url | https://www.mdpi.com/2077-0383/11/11/3193 |
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