Methotrexate in monotherapy or combined with oral steroids for bullous pemphigoid in a real-life setting: A retrospective monocentric cohort

IF 3.1 4区医学 Q2 DERMATOLOGY

Annales De Dermatologie Et De Venereologie Pub Date : 2025-02-11 DOI:10.1016/j.annder.2024.103329

M. Rodriguez , A. Du Thanh , C. Girard , C. Lesage , L. Meunier , D. Bessis , M.-C. Picot , O. Dereure

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引用次数: 0

Abstract

Background

In bullous pemphigoid (BP), prolonged treatment with low-dose methotrexate (MTX) may represent an effective strategy to maintain an initial clinical remission achieved by short-duration superpotent topical steroids (STS).).

Patients and methods

To evaluate the efficacy and safety of MTX in a real-life setting, a retrospective analysis was conducted in a reference centre for all BP patients treated between 2015 and 2020 with STS and MTX, either in monotherapy (mMTX) or in combination with oral steroids (MTX+OS). The primary endpoints were BP relapse rate and time to relapse during treatment for patients achieving initial disease control (IDC). Secondary endpoints included IDC achievement rate, relapse rate and time to relapse after MTX discontinuation, adverse effect (AE) and mortality rates, number of patients permanently discontinuing MTX owing to AE, number of patients alive and still in complete remission (CR) at the latest updates, and whether they were off treatment (cure rate).

Results

The BP relapse rate during treatment after achievement of IDC was significantly higher in patients treated with mMTX (32.2%) than with MTX+OS (0%) (p = 0.03); mean time to relapse was 10.3 months. The BP relapse rate after MTX discontinuation and the cure rate did not differ significantly between the two groups. One patient (receiving mMTX) died during follow-up and 27.8% of patients experienced at least one AE during the study. The cure rate in patients achieving IDC was 45.2% with mMTX vs. 30% with MTX+OS (p = 0.15).

Conclusion

Our study highlights the value of low-dose mMTX for treating BP in a real-life setting, both for achievement of initial response and for long-term control, with a good overall safety profile and no significant additional mortality risk in elderly subjects. However, relapses appear to have been less frequent during treatment when MTX was initially combined with OS.

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甲氨蝶呤单药治疗或联合口服类固醇治疗大疱性类天疱疮：一项回顾性单中心队列研究

背景：对于大疱性类天疱疮（BP），长期使用低剂量甲氨蝶呤（MTX）治疗可能是一种有效的策略，可以维持短期超强外用类固醇（STS）获得的初步临床缓解。为了评估MTX在现实生活中的疗效和安全性，在一个参考中心对2015年至2020年期间接受STS和MTX治疗的所有BP患者进行了回顾性分析，无论是单药治疗（mMTX）还是联合口服类固醇（MTX+OS）。主要终点是治疗期间达到初始疾病控制（IDC）的患者的血压复发率和复发时间。次要终点包括IDC成活率、MTX停药后的复发率和复发时间、不良反应（AE）和死亡率、因AE而永久停药的患者人数、最新更新时存活且仍处于完全缓解（CR）的患者人数以及是否停止治疗（治愈率）。结果mMTX组达到IDC后治疗期间血压复发率（32.2%）明显高于MTX+OS组（0%）（p = 0.03）；平均复发时间为10.3 个月。两组间甲氨蝶呤停药后血压复发率及治愈率无显著差异。1例患者（接受mMTX）在随访期间死亡，27.8%的患者在研究期间至少经历一次AE。mMTX组达到IDC的治愈率为45.2%，而MTX+OS组为30% （p = 0.15）。结论：我们的研究强调了低剂量mMTX在现实生活中治疗BP的价值，无论是在实现初始反应还是长期控制方面，都具有良好的总体安全性，并且在老年受试者中没有显著的额外死亡风险。然而，当MTX最初与OS联合使用时，复发的频率似乎更低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annales De Dermatologie Et De Venereologie 医学-皮肤病学

CiteScore

1.40

自引率

0.00%

发文量

审稿时长

81 days

期刊介绍： Les Annales de dermatologie sont le rendez-vous mensuel incontournable de toute la dermatologie francophone, grâce à leur comité de rédaction qui assure une sélection rigoureuse des articles selon les normes de l''édition scientifique internationale. Une revue didactique, véritable aide à la pratique médicale quotidienne Pour compléter et enrichir la partie scientifique, la rubrique Formation médicale continue propose aux lecteurs des textes didactiques et interactifs (Cas pour diagnostic, Notes de pharmacovigilance, la Question du praticien, Dermatologie chirurgicale, la Sélection bibliographique du mois...) qui les font bénéficier d''une formation post-universitaire diversifiée et de qualité. La revue consacre également un espace pour la publication de questions des lecteurs auxquelles des experts apportent une réponse.