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January 1993

Controlled Trial of Azathioprine and Plasma Exchange in Addition to Prednisolone in the Treatment of Bullous Pemphigoid

Author Affiliations

From the Departments of Dermatology, Hôpital H. Mondor, Créteil, France (Drs Guillaume, Prost, and Roujeau), Hôpital Trousseau, Tours, France (Drs Vaillant and Machet), Hôpital Dupuytren, Limoges, France (Drs Bernard and Aldigier), Hôpital Bichat, Paris, France (Drs Picard and Crickx), Hôpital Sud, Amiens, France (Dr Labeille), Hôpital St Charles, Montpellier, France (Dr Guillot), Hôpital de St-Germain-en-Laye (France) (Dr Foldès-Pauwels), Hôpital St-Louis, Paris, France (Dr Cordoliani), Hôpital de St Cloud (France) (Dr Prigent), Hôpital C. Nicolle, Rouen, France (Dr Joly), Hôpital Sebastopol, Reims, France (Dr Salagnac).

Arch Dermatol. 1993;129(1):49-53. doi:10.1001/archderm.1993.01680220061016

† Background and Design.—  Bullous pemphigoid is usually treated with systemic corticosteroids. Side effects are common in elderly patients, justifying the search for adjuvant therapy. This randomized, multicentric unblind study was designed to assess the efficacy of azathioprine or plasma exchange when added to conventional doses of prednisolone. One hundred patients with active disease entered the study. They were randomly allocated to receive 28 days of treatment with oral prednisolone sodium metasulfobenzoate (1 mg/kg per day) either alone or in combination with oral azathioprine (100 to 150 mg/d) or four large-volume plasma exchanges. After 28 days, the prednisolone doses were progressively decreased according to the same strict regimen in the three groups (in combination with oral azathioprine in group 2).

Results.—  The clinical results were evaluable in 98 of the evaluable patients included in the study. There was no appreciable difference in the percentages of complete remission of the disease in the three therapeutic groups at 28 days (71%, 80%, and 71%, respectively) or at 6 months (42%, 39%, and 29%, respectively). Severe complications were more often observed among patients receiving azathioprine. At 6 months, 14 of 98 patients had died, without any differences noted among the three study groups.

Conclusions.—  We conclude that neither azathioprine nor plasma exchange is effective enough to be used routinely as an adjuvant to corticosteroids in the management of bullous pemphigoid.(Arch Dermatol. 1993;129:49-53)