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Beissert and colleagues1 are to be commended for conducting one of the few randomized therapeutic trials on bullous pemphigoid. They conclude that mycophenolate mofetil is preferable to azathioprine when combined with oral methylprednisolone for the treatment of bullous pemphigoid because it is similarly effective but less toxic.
However, the opposite conclusion can be drawn from the data presented—that azathioprine is more effective and overall just as safe as mycophenolate mofetil. The time to induce complete remission, cumulative dose of steroids used, and duration of remission were all better in patients treated with azathioprine than in those treated with mycophenolate mofetil. The statistical significance of these findings was not analyzed, but some of the differences are impressive. The average time to induce complete remission was 50% shorter, and time to induce remission in 100% of patients was 3 times shorter in patients treated with azathioprine (n = 38) than in those treated with mycophenolate mofetil (n = 35). The cumulative dose of steroids used was 15% less, and the duration of remissions was 30% longer in patients treated with azathioprine.
Bystryn J. Comparative Effectiveness of Azathioprine or Mycophenolate Mofetil as an Adjuvant for the Treatment of Bullous Pemphigoid. Arch Dermatol. 2008;144(7):946. doi:10.1001/archderm.144.7.946-a