1
|
Intravenous immunoglobulin in patients with bullous pemphigoid insufficient response to corticosteroids: Nationwide post-marketing surveillance in Japan. J Dermatol Sci 2023; 109:22-29. [PMID: 36697305 DOI: 10.1016/j.jdermsci.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/19/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND In Japan, intravenous immunoglobulin (IVIG) has been approved for corticosteroid-unresponsive bullous pemphigoid (BP); however, its usage, efficacy, and safety in clinical settings remain unclear. OBJECTIVE To elucidate IVIG efficacy, we examined the improvement in disease severity based on the Bullous Pemphigoid Disease Area Index (BPDAI). METHODS In this 3-year (April 2016-March 2019), prospective, post-marketing, observational surveillance study, we enrolled 379 patients (51.3 % men; mean age, 74.5 years) with corticosteroid-unresponsive BP treated with IVIG from 143 institutions in Japan (720 treatment cycles). The percentage of patients who improved by at least one severity stage or whose symptoms completely resolved based on the BPDAI score was evaluated at 15, 30, and 60-90 days. RESULTS The improvement rates at 15, 30, and 60-90 days after initial treatment in the 328 IVIG-naïve patients were 70.7 %, 83.5 %, and 84.3 %, respectively. The BPDAI score decreased rapidly and significantly by 15 days compared with that observed during pre-treatment. Further improvement was observed at 30 and 60-90 days. The corticosteroid dose and anti-BP180 antibody titers decreased significantly post-treatment (both, p < .001). Approximately 25 % of IVIG-naïve patients underwent multiple treatment cycles. The improvement rate at 30 days after the final dose was 88 %, and the symptoms completely resolved in 44 % of patients. The incidence of adverse drug reactions per cycle was 8.34 %; the most common reaction was transient thrombocytopenia. CONCLUSION Most patients showed improvement in severity and decrease in corticosteroid dose and anti-BP180 antibody levels post-treatment, indicating that IVIG is useful for corticosteroid-unresponsive BP treatment.
Collapse
|
2
|
Sadik CD, Rashid H, Hammers CM, Diercks GFH, Weidinger A, Beissert S, Schauer F, Fettiplace J, Thaçi D, Ngai Y, Nunn MA, Zillikens D, Horváth B. Evaluation of Nomacopan for Treatment of Bullous Pemphigoid: A Phase 2a Nonrandomized Controlled Trial. JAMA Dermatol 2022; 158:641-649. [PMID: 35507334 PMCID: PMC9069343 DOI: 10.1001/jamadermatol.2022.1156] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Bullous pemphigoid is a difficult-to-treat autoimmune blistering skin disease that predominantly affects older adults and is associated with an increased mortality rate. Objective To examine the safety and therapeutic potential of nomacopan, an inhibitor of leukotriene B4 and complement C5, in patients with bullous pemphigoid. Design, Setting, and Participants This multicenter, single-group, phase 2a nonrandomized controlled trial was conducted in the dermatology departments of universities in the Netherlands and Germany. Participants were enrolled between September 2018 and April 2020. Older adult patients (aged ≥55 years) with mild to moderate, new-onset or relapsing bullous pemphigoid were recruited into the study. Interventions Patients received nomacopan, 90 mg, subcutaneously on day 1 and 30 mg subcutaneously daily until day 42. Main Outcomes and Measures The primary end point was the proportion of patients with grade 3 to 5 (severe) adverse events associated or possibly associated with nomacopan. Secondary end points included mean absolute and percentage changes in the Bullous Pemphigoid Disease Area Index (BPDAI) activity score, the BPDAI pruritus score, and the patient-reported outcome measures Dermatology Life Quality Index (DLQI) and Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL). Results A total of 9 patients (median [range] age, 75 [55-85] years) with bullous pemphigoid were included in the trial, of whom 5 were women (55.6%). No serious adverse events associated with nomacopan were found. The mean (90% CI) BPDAI activity score decreased from 32.0 (8.7) points on day 1 to 19.6 (9.0) points on day 42. Seven of 9 patients (77.8%) responded to nomacopan with a reduction in the BPDAI activity score of at least 8 points between days 1 and 42; in 3 responders, the reduction was 80% or greater. On day 42, the mean (90% CI) BPDAI pruritus score had decreased by 6.8 (4.6) points from 17.6 (4.0) points on day 1. The mean (90% CI) DLQI score decreased from 11.3 (4.2) points at baseline to 6.4 (3.8) points by day 42, and the mean (90% CI) TABQOL score decreased from 14.6 (5.4) points at baseline to 10.3 (5.0) points on day 42. Conclusions and Relevance Results of this nonrandomized controlled trial suggest that nomacopan can be well tolerated in older patients with bullous pemphigoid and may have therapeutic benefits for suppressing acute flares of this disease. A larger, placebo-controlled randomized clinical trial is warranted to confirm this safety profile and to establish nomacopan as a new therapeutic option for bullous pemphigoid. Trial Registration ClinicalTrials.gov Identifier: NCT04035733.
Collapse
Affiliation(s)
- Christian D Sadik
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Hanan Rashid
- Department of Dermatology, Center of Blistering Diseases, European Reference Network-Skin, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christoph M Hammers
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Gilles F H Diercks
- Department of Dermatology, Center of Blistering Diseases, European Reference Network-Skin, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anke Weidinger
- Department of Dermatology and Allergy, University of Kiel, Kiel, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Franziska Schauer
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Diamant Thaçi
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | | | | | - Detlef Zillikens
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Barbara Horváth
- Department of Dermatology, Center of Blistering Diseases, European Reference Network-Skin, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
3
|
Ruggiero A, Megna M, Villani A, Comune R, Fabbrocini G, di Vico F. Strategies to Improve Outcomes of Bullous Pemphigoid: A Comprehensive Review of Clinical Presentations, Diagnosis, and Patients' Assessment. Clin Cosmet Investig Dermatol 2022; 15:661-673. [PMID: 35444441 PMCID: PMC9014958 DOI: 10.2147/ccid.s267573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023]
Abstract
Bullous pemphigoid (BP) is the most frequent autoimmune bullous disease mainly affecting elderlies. Diagnosis usually results from clinical features, histological examination, and the quantification of circulating typical autoantibodies, due to its higher incidence in elderly patients, bullous pemphigoid treatment and management still represents a challenge due to the higher frequency of several comorbidities in this group of patients, which may also be linked to a reduced tolerance to BP treatments. Hence, an early diagnosis and a prompt correct treatment are mandatory to reach better clinical outcomes and improve as much as possible BP outcomes. Herein, we carried out a comprehensive literature review about the known clinical presentations, diagnosis, assessment and monitoring procedures used in daily clinical practice in patients with BP, to better define strategies to improve as much as possible BP clinical outcomes.
Collapse
Affiliation(s)
- Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Alessia Villani
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Rosita Comune
- Section of Radiology and Radiotherapy, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, 80138, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Francesca di Vico
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| |
Collapse
|
4
|
Assessing Disease Outcome Measures in Bullous Pemphigoid on Standard-Of-Care Therapies. JID INNOVATIONS 2021; 1:100050. [PMID: 34909747 PMCID: PMC8659387 DOI: 10.1016/j.xjidi.2021.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/21/2022] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering disease resulting in pruritus and cutaneous blistering. Longitudinal studies characterizing the disease course of patients with BP on conventional therapy are lacking. We sought to characterize the changes in disease activity and pruritus of patients with BP on standard-of-care treatments. We conducted a retrospective cohort study on patients with BP on standard-of-care therapy. Generalized Estimating Equations were used to estimate the mean and standard errors for Bullous Pemphigoid Disease Activity Index (BPDAI) total activity score, BPDAI pruritus component score, and anti-BP180 autoantibody levels (BP180) over time. A total of 80 patients with BP showed consistent reductions in BPDAI total activity score and BPDAI pruritus component score, with a nadir at 4 months. BP180 decreased over time, with the largest reductions at 6 and 9 months. Median partial/complete remission was at 6.7 months, with relapses at a median time of 15.9 months. Receiving operating characteristic analysis determined an optimal BPDAI total activity score cutoff of 3.3 to discriminate partial/complete remission incidence (area under the curve = 0.895, sensitivity = 0.844, specificity = 0.78). In conclusion, in patients with BP on standard-of-care therapy, a natural course of BPDAI total activity score and BPDAI pruritus component score over time was comprehensively projected. BPDAI ≤ 3.3 was associated with partial/complete remission. These results provide reference data to guide future clinical trial design for BP.
Collapse
|
5
|
Messingham KN, Cahill MP, Kilgore SH, Munjal A, Schlievert PM, Fairley JA. TSST-1 +Staphylococcus aureus in Bullous Pemphigoid. J Invest Dermatol 2021; 142:1032-1039.e6. [PMID: 34606884 DOI: 10.1016/j.jid.2021.08.438] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 01/31/2023]
Abstract
A potential role of Staphylococcus aureus in bullous pemphigoid was explored by examining the colonization rate in patients with new-onset disease compared with that in age- and sex-matched controls. S. aureus colonization was observed in 85% of bullous pemphigoid lesions, 3-6-fold higher than the nares or unaffected skin from the same patients (P ≤ 0.003) and 6-fold higher than the nares or skin of controls (P ≤ 0.0015). Furthermore, 96% of the lesional isolates produced the toxic shock syndrome toxin-1 superantigen, and most of these additionally exhibited homogeneous expression of the enterotoxin gene cluster toxins. Toxic shock syndrome toxin-1‒neutralizing antibodies were not protective against colonization. However, S. aureus colonization was not observed in patients who had recently received antibiotics, and the addition of antibiotics with staphylococcal coverage eliminated S. aureus and resulted in clinical improvement. This study shows that toxic shock syndrome toxin-1‒positive S. aureus is prevalent in bullous pemphigoid lesions and suggests that early implementation of antibiotics may be of benefit. Furthermore, our results suggest that S. aureus colonization could provide a source of infection in patients with bullous pemphigoid, particularly in the setting of high-dose immunosuppression.
Collapse
Affiliation(s)
- Kelly N Messingham
- Department of Dermatology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA.
| | - Michael P Cahill
- Department of Microbiology and Immunology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Samuel H Kilgore
- Department of Microbiology and Immunology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Ananya Munjal
- Department of Dermatology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Patrick M Schlievert
- Department of Microbiology and Immunology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Janet A Fairley
- Department of Dermatology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
6
|
Didona D, Scarsella L, Fehresti M, Solimani F, Juratli HA, Göbel M, Mühlenbein S, Holiangu L, Pieper J, Korff V, Schmidt T, Sitaru C, Eming R, Hertl M, Pollmann R. Autoreactive Peripheral Blood T Helper Cell Responses in Bullous Pemphigoid and Elderly Patients With Pruritic Disorders. Front Immunol 2021; 12:569287. [PMID: 33841390 PMCID: PMC8027500 DOI: 10.3389/fimmu.2021.569287] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
Bullous pemphigoid (BP) is a prototypic autoimmune disorder of the elderly, characterized by serum IgG autoantibodies, namely anti-BP180 and anti-BP230, directed against components of the basal membrane zone that lead to sub-epidermal loss of adhesion. Pruritus may be indicative of a pre-clinical stage of BP, since a subset of these patients shows serum IgG autoantibodies against BP230 and/or BP180 while chronic pruritus is increasingly common in the elderly population and is associated with a variety of dermatoses. Clinical and experimental evidence further suggests that pruritus of the elderly may be linked to autoimmunity with loss of self-tolerance against cutaneous autoantigens. Thus, the objective of this study was to determine autoreactive T cell responses against BP180 in elderly patients in comparison to patients with BP. A total of 22 elderly patients with pruritic disorders, 34 patients with bullous or non-bullous BP and 34 age-matched healthy controls were included in this study. The level of anti-BP180 and anti-BP230 IgG serum autoantibodies, Bullous Pemphigoid Disease Area Index (BPDAI), and pruritus severity were assessed for all patients and controls. For characterization of the autoreactive T cell response, peripheral blood mononuclear cells were stimulated ex vivo with recombinant BP180 proteins (NH2- and COOH-terminal domains) and the frequencies of BP180-specific T cells producing interferon-γ, interleukin (IL)-5 or IL-17 were subsequently determined by ELISpot assay. Patients with BP showed a mixed Th1/Th2 response against BP180 while autoreactive Th1 cells were identified in a minor subset of elderly patients with pruritic disorders. Furthermore, our T cell characterization revealed that therapeutic application of topical clobetasol propionate ointment in BP patients significantly reduced peripheral blood BP180-specific T cells, along with clinically improved symptoms, strongly suggesting a systemic immunosuppressive effect of this treatment.
Collapse
Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Luca Scarsella
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Milad Fehresti
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Farzan Solimani
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hazem A. Juratli
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Manuel Göbel
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Stefan Mühlenbein
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Lily Holiangu
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Josquin Pieper
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Vera Korff
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Thomas Schmidt
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Cassian Sitaru
- Department of Dermatology and Allergology, Universität Freiburg, Freiburg, Germany
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Robert Pollmann
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| |
Collapse
|
7
|
Gore Karaali M, Koku Aksu AE, Cin M, Leblebici C, Kara Polat A, Gurel MS. Tissue eosinophil levels as a marker of disease severity in bullous pemphigoid. Australas J Dermatol 2021; 62:e236-e241. [PMID: 33748980 DOI: 10.1111/ajd.13547] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Eosinophils play an important role in bullous pemphigoid (BP) pathogenesis. Although tissue infiltration with eosinophils has been known for a long time, there is a lack of knowledge about the relationship between tissue eosinophil levels and disease severity and clinical characteristics of the patients. METHODS Fifty-nine patients diagnosed with BP between January 2008 and December 2018 were reviewed. Haematoxylin-Eosin (H&E)-stained preparations were re-evaluated in terms of tissue eosinophil levels. For disease severity, Bullous Pemphigoid Disease Area Index (BPDAI) was used. The relationship between tissue eosinophil levels and disease severity and clinical features were evaluated. RESULTS Erosion/blister and urticaria/erythema BPDAI scores were higher in the group with high tissue eosinophil level than the group with low tissue eosinophil level. Tissue and peripheral blood eosinophil count were correlated with total urticaria/erythema BPDAI scores. There was no correlation between blood and tissue eosinophil count. The mortality rate was 64.7% vs 44.0% in the high vs low tissue eosinophil groups. Tissue eosinophil levels were high in patients with BP accompanying neurological disease. CONCLUSIONS Tissue eosinophil count and peripheral blood eosinophil count were correlated with disease severity in BP. Tissue eosinophil levels were also high in patients with BP accompanying neurological disease.
Collapse
Affiliation(s)
- Muge Gore Karaali
- Department of Dermatology, Mengücek Gazi Training and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Ayse Esra Koku Aksu
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Merve Cin
- Department of Pathology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Asude Kara Polat
- Department of Dermatology, University of Health Science (HSU) Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Salih Gurel
- Department of Dermatology, Göztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| |
Collapse
|
8
|
Masmoudi W, Vaillant M, Vassileva S, Patsatsi A, Quereux G, Moltrasio C, Abasq C, Prost-Squarcioni C, Kottler D, Kiritsi D, Litrowski N, Plantin P, Friedrichsen L, Zebrowska A, Duvert-Lehembre S, Hofmann S, Ferranti V, Jouen F, Joly P, Hebert V. International validation of the Bullous Pemphigoid Disease Area Index severity score and calculation of cut-off values for defining mild, moderate and severe types of bullous pemphigoid. Br J Dermatol 2020; 184:1106-1112. [PMID: 33067805 DOI: 10.1111/bjd.19611] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Bullous Pemphigoid Disease Area Index (BPDAI) score has been proposed to provide an objective measure of bullous pemphigoid (BP) activity. OBJECTIVES The objective of this study was to calculate BPDAI cut-off values defining mild, moderate and severe BP. We also aimed to assess the interrater reliability and correlation with the number of daily new blisters, and anti-BP180 and anti-BP230 antibodies. METHODS Severity scores were recorded by two blinded investigators. Anti-BP180 and anti-BP230 antibodies were measured using an enzyme-linked immunosorbent assay (ELISA). Cut-off values defining mild, moderate and severe subgroups were calculated based on the 25th and 75th percentiles of the BPDAI score. RESULTS In total, 285 patients with BP were enrolled from 50 dermatology departments in Europe. Median BPDAI activity was 37·5 points (range 0-164). Cut-off values corresponding to the first and third quartiles of the BPDAI score were 20 and 57, respectively; thus, these values were used to define mild (≤ 19), moderate (≥ 20 and ≤ 56) and severe (≥ 57) BP. The median BPDAI score for patients with ≤ 10 daily new blisters was 26 [interquartile range (IQR) 17-45], and for patients with > 10 daily new blisters the median score was 55 (IQR 39-82). The BPDAI intraclass correlation coefficient measured at baseline was 0·97 and remained higher than 0·90 up to month 6. The improvement in the BPDAI score was correlated with the absolute decrease in anti-BP180 ELISA value (Spearman's rank r = 0·34, P < 0·004), but not with anti-BP230 antibodies (r = 0·17, P = 0·15). CONCLUSIONS This study suggests cut-off values of 20-57 for BPDAI to distinguish mild, moderate and severe BP, and confirms that it is a robust tool to assess BP severity precisely.
Collapse
Affiliation(s)
- W Masmoudi
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes
| | - M Vaillant
- Department of Immunology, INSERM U1234, Rouen University Hospital, Rouen, France
| | - S Vassileva
- Department of Dermatology, Medical University of Sofia, Sofia, Bulgaria
| | - A Patsatsi
- 2nd Department of Dermatology and Venerology, Papageorgiou General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece
| | - G Quereux
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | - C Moltrasio
- Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Abasq
- Department of Dermatology, Brest University Hospital, Brest, France
| | - C Prost-Squarcioni
- Department of Dermatology, Avicenne Hospital, University Paris 13, Bobigny, France
| | - D Kottler
- Department of Dermatology, Bichat Hospital, AP-HP, Paris, France
| | - D Kiritsi
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - N Litrowski
- Department of Dermatology, Monod General Hospital, Le Havre, France
| | - P Plantin
- Department of Dermatology, Centre Hospitalier de Cornouaille, Quimper, France
| | - L Friedrichsen
- Department of Dermatology, University of Lubeck, Lubeck, Germany
| | - A Zebrowska
- Department of Dermatology and Venerology, Medical University of Lodz, Lodz, Poland
| | | | - S Hofmann
- Department of Dermatology, HELIOS University of Wuppertal, Wuppertal, Germany
| | - V Ferranti
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes
| | - F Jouen
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes.,Department of Immunology, INSERM U1234, Rouen University Hospital, Rouen, France
| | - P Joly
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes.,Department of Immunology, INSERM U1234, Rouen University Hospital, Rouen, France
| | - V Hebert
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes.,Department of Immunology, INSERM U1234, Rouen University Hospital, Rouen, France
| | | |
Collapse
|
9
|
Nesmond S, Muller C, Le Naour R, Viguier M, Bernard P, Antonicelli F, Le Jan S. Characteristic Pattern of IL-17RA, IL-17RB, and IL-17RC in Monocytes/Macrophages and Mast Cells From Patients With Bullous Pemphigoid. Front Immunol 2019; 10:2107. [PMID: 31572359 PMCID: PMC6749098 DOI: 10.3389/fimmu.2019.02107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/21/2019] [Indexed: 01/08/2023] Open
Abstract
Inflammation is largely implicated in bullous pemphigoid (BP), the most frequent skin auto-immune blistering disease. IL-17, essentially IL-17A/F, has been involved in blister formation through regulation of protease production, and its specific serum profile within BP was related to disease outcome. However, relationships between IL-17 family ligands and receptors are quite complex with six different IL-17 isoforms, and five different receptors. We here aimed at clarifying the contribution of the IL-17 axis in BP by characterizing not only the expression of IL-17 receptor (IL-17R) members within immune cells isolated from BP patients (PMNs, n = 9; T-lymphocytes, n = 10; and monocytes, n = 10) but also the expression of IL-17 isoforms in sera (n = 83), and blister fluid (n = 31) of BP patients. We showed that at diagnosis, IL-17RA and IL-17RC expression were significantly increased in monocytes isolated from BP patients as compared to those from control subjects (p = 0.006 and p = 0.016, respectively). Notably, both IL-17RA and IL-17RC mRNA expression remained elevated in BP monocytes at time of relapse. We further demonstrated a significant increase of all IL-17 isoforms tested in BP blister fluid compared with BP serum (IL-17A, p < 0.0001; IL-17A/F, p < 0.0001; IL-17B, p = 0.0023; IL-17C, p = 0.0022; IL-17E, p < 0.0001). Among all, IL-17B was the only cytokine for which a significant decreased concentration within blister fluid was observed in BP patients with severe disease compared to patients with moderate disease (p = 0.012). We further evidenced a significant negative correlation between IL-17B levels and blister/erosion BPDAI subscore (r = −0.52, p = 0.003). We finally identified mast cells as a potential target of IL-17B in lesional skin of BP patients. In conclusion, we showed here that IL-17RA and IL-17RC expression in monocyte was associated with disease activity and evidenced in situ a negative correlation between BP disease activity and IL-17B, whose effects could be mediated by IL-17RB expressed by mast cell in BP lesional skin.
Collapse
Affiliation(s)
- Stéphane Nesmond
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France
| | - Céline Muller
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France
| | - Richard Le Naour
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France.,Department of Biological Sciences, UFR Pharmacy, University of Reims Champagne-Ardenne, Reims, France
| | - Manuelle Viguier
- Department of Dermatology, University Hospital, University of Reims-Champagne-Ardenne, Reims, France
| | - Philippe Bernard
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France.,Department of Dermatology, University Hospital, University of Reims-Champagne-Ardenne, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, UFR Odontology, University of Reims-Champagne-Ardenne, Reims, France
| | - Sébastien Le Jan
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France
| |
Collapse
|
10
|
Smith H, Mohd Mustapa MF, Cheung ST, de Berker DAR. National audit on the management of bullous pemphigoid. Clin Exp Dermatol 2019; 45:289-294. [PMID: 31502666 DOI: 10.1111/ced.14086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune, subepidermal, blistering condition that typically affects elderly people. AIM To undertake a national clinical audit based on standards derived from the British Association of Dermatologists (BAD) clinical guidelines on the management of BP. METHODS In 2018, BAD members were invited to submit data for five consecutive adults with BP per centre, who had been under hospital supervision for at least 12 months, in a national audit over an 11-week period. RESULTS In total, 123 responders from 120 hospitals provided data for 524 cases. Diagnosis was made either clinically (10.7%; 56 of 524) or through histology with direct immunofluorescence (41.6%; 218 of 524), indirect immunofluorescence (10.3%; 54 of 524) or both (37.4%; 196 of 524). Most patients had very mild baseline disease (63.9%; 225 of 352) with 21.9% (77 of 352) considered mild, 9.8% (31 of 352) moderate and 5.4% (19 of 352) severe. Documentation of diabetes, glycated haemoglobin (HbA1c), blood pressure and hypertension was available for 54.1% (283 of 523), 51% (267 of 524), 44.2% (231 of 522) and 61.5% (321 of 522) of cases, respectively. Oral corticosteroids were commenced in 85.5% (448 of 524) of patients, with 38.4% (172 of 448) of these having documented risk of osteoporosis; data regarding prescription of bone-protection therapies were available for 99.7% (447 of 448) of cases, with 75.6% (338 of 447) of these having a bone-protection prescription. Patient satisfaction was documented in 59.3% (310 of 523) of cases. Systemic treatment was commenced in 95.9% (502 of 524) of cases during the 12-month assessment period, with baseline blood test and follow-up data available for 96.6% (485 of 502) and 95.6% (480 of 502), respectively. Documentation of baseline blood tests was available for 87.4% (424 of 485) of cases, with follow-up tests recorded in 69.8% (335 of 480). CONCLUSION Overall, compliance with elements of documentation was moderate or low, whereas standards pertaining to direct care were high.
Collapse
Affiliation(s)
- H Smith
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - D A R de Berker
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
| |
Collapse
|
11
|
Pharmacological advances in pemphigoid. Curr Opin Pharmacol 2019; 46:34-43. [DOI: 10.1016/j.coph.2018.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 12/17/2022]
|
12
|
Duretz C, Antonicelli F, Muller C, Antonicelli N, Plee J, Viguier M, Bernard P. Association of Transient Palmoplantar Keratoderma With Clinical and Immunologic Characteristics of Bullous Pemphigoid. JAMA Dermatol 2019; 155:216-220. [PMID: 30484821 DOI: 10.1001/jamadermatol.2018.4084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance Development of transient palmoplantar keratoderma (PPK) with bullous pemphigoid (BP) has only been described in 2 isolated case reports. The clinical significance and the pathophysiologic mechanisms of this association are unknown. Objective To examine the clinical characteristics and immunological profile of patients with BP who develop transient PPK and analyze therapeutic options and outcomes. Design, Setting, and Participants In this case series, patients with BP who developed acquired, transient PPK, and were treated at a single institution from January 1, 2015, through December 31, 2017, were studied. Main Outcomes and Measures Clinical and immunological activity of BP, treatment administrated before and after PPK appearance, and patient outcomes. Results Six patients with BP and transient PPK were identified and included in the study. There were 5 women and 1 man with a mean age of 72 years. At baseline, all patients had a generalized, multibullous BP and high serum anti-BP180 antibodies (mean, 130 U/mL; range, 73-150), whereas anti-BP230 antibodies were elevated in only 1 case. The PPK appeared a mean 6.2 (range, 2-12) months after BP diagnosis, following a prolonged period of disease activity with recurrent flares. When the PPK occurred, BP was uncontrolled on therapy (mean Bullous Pemphigoid Disease Activity Index [BPDAI] score, 57; range, 34-105; mean anti-BP180 antibodies titer, 122 U/mL; range, 81-150). On administration of additional systemic immunosuppressive therapies, the PPK healed progressively in a mean 4.3 months (range, 2-9), along with BP clinical remission in 4 of 6 patients. No relationship was found between PPK occurrence and anti-BP180/230 antibodies profiles. In contrast, blister fluids collected at the time of PPK displayed a much higher level of interleukin 1β (IL-1β) compared with those collected in the absence of PKK. Expression of IL-17A, IL-17F, and IL-22 was also enhanced in the blister fluid of patients with BP who had PPK. Conclusions and Relevance To our knowledge, this is the first report of 6 cases of BP with transient PPK with extensive immunological investigation. The PPK appeared after a prolonged period of clinical BP activity punctuated with recurrent relapses, was transient, and healed after BP control with additional immunosuppressive therapy. Enhanced expression of a particular cytokine panel in the blister fluid at time of PPK could support keratinocyte proliferation as described in patients with psoriasis. Transient PPK could represent a clinical marker of severe, treatment-resistant BP.
Collapse
Affiliation(s)
- Claire Duretz
- Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, Faculty of Medicine, EA 7509, University of Reims Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, UFR Odontology, University of Reims Champagne-Ardenne, Reims, France
| | - Céline Muller
- Laboratory of Dermatology, Faculty of Medicine, EA 7509, University of Reims Champagne-Ardenne, Reims, France
| | - Nina Antonicelli
- Laboratory of Dermatology, Faculty of Medicine, EA 7509, University of Reims Champagne-Ardenne, Reims, France
| | - Julie Plee
- Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Manuelle Viguier
- Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Dermatology, Faculty of Medicine, EA 7509, University of Reims Champagne-Ardenne, Reims, France
| | - Philippe Bernard
- Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Dermatology, Faculty of Medicine, EA 7509, University of Reims Champagne-Ardenne, Reims, France
| |
Collapse
|
13
|
Daneshpazhooh M, Ghiasi M, Lajevardi V, Nasiri N, Balighi K, Teimourpour A, Khosravi H, Saeidi V, Mahmoudi H, Chams-Davatchi C. BPDAI and ABSIS correlate with serum anti-BP180 NC16A IgG but not with anti-BP230 IgG in patients with bullous pemphigoid. Arch Dermatol Res 2018; 310:255-259. [PMID: 29423547 DOI: 10.1007/s00403-018-1817-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 12/23/2022]
Abstract
Bullous pemphigoid (BP) is an autoimmune bullous disease characterized by autoantibody production against BP180 and BP230. Two scoring systems have been validated for BP including: Bullous Pemphigoid Disease Area Index (BPDAI) and Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). In this study, we investigated correlations between both scoring systems and either anti-BP180 NC16A or anti-BP230 values. BPDAI and ABSIS were used to measure disease activity in 95 BP patients at Razi Hospital in Tehran, Iran. ELISA was performed on patient sera to identify any significant relationship between anti-BP180 NC16A/anti-BP230 values and BP disease activity. The two scores showed a strong correlation (ρ = 0.73; p value < 0.0001). Anti-BP180 NC16A values correlated with BPDAI (ρ = 0.49, p value = 0.0001), ABSIS (ρ = 0.47, p value < 0.0001), and BPDAI-Pruritus scores (ρ = 0.29, p value < 0.005). There was a strong correlation between anti-BP180 NC16A values and the ABSIS Skin score (ρ = 0.58, p value < 0.0001), and a moderate correlation with erosion/blister BPDAI score (ρ = 0.48, p value < 0.001) and urticaria/erythema BPDAI score (ρ = 0.27, p value = 0.009). Anti-BP230 values did not demonstrate any relationship with either scores or their subcomponents. Both scoring systems demonstrated moderate validity. Mucosal components did not show any correlation with anti-BP antibodies and are disproportionately presented in both BP scoring tools.
Collapse
Affiliation(s)
- Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Vahdate-Eslami Square, Tehran, 11996, Iran.
| | - Maryam Ghiasi
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Vahdate-Eslami Square, Tehran, 11996, Iran
| | - Vahideh Lajevardi
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Vahdate-Eslami Square, Tehran, 11996, Iran
| | - Nafise Nasiri
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Vahdate-Eslami Square, Tehran, 11996, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Vahdate-Eslami Square, Tehran, 11996, Iran
| | - Amir Teimourpour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Vahide Saeidi
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Vahdate-Eslami Square, Tehran, 11996, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Vahdate-Eslami Square, Tehran, 11996, Iran
| | - Cheyda Chams-Davatchi
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Vahdate-Eslami Square, Tehran, 11996, Iran
| |
Collapse
|
14
|
Clapé A, Muller C, Gatouillat G, Le Jan S, Barbe C, Pham BN, Antonicelli F, Bernard P. Mucosal Involvement in Bullous Pemphigoid Is Mostly Associated with Disease Severity and to Absence of Anti-BP230 Autoantibody. Front Immunol 2018; 9:479. [PMID: 29662486 PMCID: PMC5890137 DOI: 10.3389/fimmu.2018.00479] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/22/2018] [Indexed: 01/10/2023] Open
Abstract
Bullous pemphigoid (BP) is the most common autoimmune bullous disease and typically affects the elderly. Binding of specific autoantibodies to BP180/230 hemidesmosomal components induces an inflammatory response leading to skin blister formation. Unusual manifestations of BP include additional mucous membrane involvement, without pathophysiological knowledge associated to the formation of these lesions. We here performed a prospective study on series of consecutive BP patients with (n = 77) and without (n = 18) mucosal involvements at baseline to further investigate why some BP patients display mucosal lesion and other not. Analysis of disease activity showed that BP patients with mucosal involvement displayed a higher total BP Disease Area Index (BPDAI) score (P = 0.008), but also higher skin and blister/erosion BPDAI scores (P = 0.02 and P = 0.001, respectively). By contrast, the erythema/urticaria BPDAI score was identical between the two groups of patients. The erythema/urticaria BPDAI score, but not the blister/erosion BPDAI score, was correlated with the serum concentration of anti-BP180 NC16A autoantibodies in patients with mucosal involvement. In multivariate analysis, the absence of anti-BP230 autoantibody was the only factor independently associated with mucosal involvement (OR 7.8; 95% CI, 3.1–19.6) (P < 0.0001). Analysis of the distribution of BP patients according to BPDAI scores revealed a shift toward higher blister/erosion BPDAI scores for BP patients with mucosal involvement. This study indicates that mucosal lesions are clinically mainly related to disease severity and immunologically to the absence of anti-BP230 antibodies.
Collapse
Affiliation(s)
- Ariane Clapé
- Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France.,Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Céline Muller
- Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France
| | - Grégory Gatouillat
- Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Sébastien Le Jan
- Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France
| | - Coralie Barbe
- Clinical Research Unit, Reims University Hospital, Reims, France
| | - Bach-Nga Pham
- Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, UFR Odontology, University of Reims Champagne-Ardenne, Reims, France
| | - Philippe Bernard
- Laboratory of Dermatology, Faculty of Medicine, EA7319, University of Reims Champagne-Ardenne, Reims, France.,Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| |
Collapse
|
15
|
Abstract
Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease in Western countries, and typically affects the elderly. BP is immunologically characterized by tissue-bound and circulating autoantibodies directed against either the BP antigen 180 (BP180, or BPAG2) or the BP antigen 230 (BP230, or BPAG1e), or even both, which are components of hemidesmosomes involved in the dermal-epidermal cohesion. Risk factors for BP include old age, neurologic diseases (dementia, Parkinson's disease, cerebrovascular disease), and some particular drugs, including loop diuretics, spironolactone and neuroleptics. The spectrum of clinical presentations is extremely broad. Clinically, BP is an intensely pruritic erythematous eruption with widespread blister formation. In the early stages, or in atypical, non-bullous variants of the disease, only excoriated, eczematous or urticarial lesions (either localized or generalized) are present. The diagnosis of BP relies on immunopathologic findings, especially based on both direct and indirect immunofluorescence microscopy observations, as well as on anti-BP180/BP230 enzyme-linked immunosorbent assays (ELISAs). BP is usually a chronic disease, with spontaneous exacerbations and remissions, which may be accompanied by significant morbidity. In the past decade, potent topical corticosteroids have emerged as an effective and safe first-line treatment for BP, but their long-term feasibility is still controversial. Newer therapeutic agents targeting molecules involved in the inflammatory cascade associated with BP represent future alternatives to classical immunosuppressant drugs for maintenance therapy.
Collapse
|
16
|
Fujio Y, Kojima K, Hashiguchi M, Wakui M, Murata M, Amagai M, Yamagami J. Validation of chemiluminescent enzyme immunoassay in detection of autoantibodies in pemphigus and pemphigoid. J Dermatol Sci 2017; 85:208-215. [PMID: 28012821 DOI: 10.1016/j.jdermsci.2016.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/24/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND A novel chemiluminescent enzyme immunoassay (CLEIA) was recently developed to quantify autoantibodies specific for desmogleins (Dsgs) and BP180, the target antigens of pemphigus and pemphigoid. This assay is automated and highly accurate and efficient. OBJECTIVE To validate the use of the CLEIA for detection of autoantibodies during the clinical courses of patients with pemphigus and pemphigoid. METHODS To define cut-off values for Dsg1, Dsg3, and BP180, we evaluated 47 serum samples from patients with pemphigus foliaceus (PF), 59 from those with pemphigus vulgaris (PV), 52 from those with bullous pemphigoid (BP), and 995 from healthy individuals. We also evaluated any fluctuations in CLEIA titers according to disease activity during the clinical course of 10 cases each of PF, PV, and BP. We used clinical symptom scores, the pemphigus disease area index (PDAI) and the bullous pemphigoid disease area index (BPDAI), to evaluate disease activity. RESULTS The cut-off values for the CLEIA titers determined by the Youden index were 15.4U/mL for Dsg1, 14.9U/mL for Dsg3, and 16.8U/mL for BP180. CLEIA titers fluctuated in parallel with the PDAI/BPDAI scores in 28 of the 30 cases with PF, PV, or BP. Although the CLEIA and enzyme-linked immunosorbent assay (ELISA) values in the same samples differed substantially in some cases, the concordance rates of positive/negative results between the CLEIA and ELISA were 96% for Dsg1, 97% for Dsg3, and 96% for BP180. CONCLUSION The CLEIA, a newly developed, highly effective autoantibody detection system, is as reliable as ELISA for evaluation of the clinical courses of pemphigus and pemphigoid.
Collapse
Affiliation(s)
- Yumi Fujio
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| | - Kazuo Kojima
- Medical & Biological Laboratories Co., LTD, 4-5-3 Sakae, Naka-Ku, Nagoya, Aichi, 460-0008, Japan.
| | - Masahiro Hashiguchi
- Medical & Biological Laboratories Co., LTD, 4-5-3 Sakae, Naka-Ku, Nagoya, Aichi, 460-0008, Japan.
| | - Masatoshi Wakui
- Department of Laboratory Medicine, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
| |
Collapse
|
17
|
Validation studies of outcome measures in pemphigus. Int J Womens Dermatol 2016; 2:128-139. [PMID: 28492025 PMCID: PMC5419045 DOI: 10.1016/j.ijwd.2016.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022] Open
Abstract
Pemphigus is a group of rare and potentially fatal autoimmune blistering diseases that are associated with auto-antibodies that target intercellular adhesion molecules. Incidence of pemphigus varies among populations, with the lowest incidence in Switzerland and Finland at 0.6–0.76 per million per year and the highest in Jewish communities at 16.1–32 per million per year. Pemphigus is associated with devastating morbidity and despite advancements in our understanding of the disease and a widening array of therapeutic options, no cure exists. The delay in the development of a cure may in part be attributed to the absence of a standardized and completely validated severity outcome measures to allow for high-quality multicenter control studies. Such a tool is necessary to define the best practice in clinical studies, allow for accurate comparisons between study results, justify drug use within the clinical setting, and reduce the cost burden that is associated with the use of ineffective therapies. Utilizing outcome measures that are not validated provides an opportunity to synthesize outcome measures with the intent to favor particular treatments and thus produce false conclusions. According to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) group, a validation of these measurement instruments requires investigating their responsiveness, reliability, and validity. More than 116 outcome measures exist to assess pemphigus severity, of which the Pemphigus Disease Area Index (PDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS), and Pemphigus Vulgaris Activity Score (PVAS) are the most comprehensively corroborated measures. With regard to validity and reliability, PDAI was unsurpassed by ABSIS and PVAS. Data indicate that ABSIS is more reliable than PVAS, but PVAS seems to have greater validity although the results are not consistent. PDAI, ABSIS, and PVAS have not yet had their responsiveness analyzed, which should be the next step to completely validate the outcome measures and conclusively determine which measure is superior.
Collapse
|
18
|
Zhao CY, Murrell DF. Outcome measures for autoimmune blistering diseases. J Dermatol 2016; 42:31-6. [PMID: 25558950 DOI: 10.1111/1346-8138.12711] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 01/19/2023]
Abstract
Outcome measures are crucial in assessing an autoimmune blistering disease's (AIBD) severity as well as its impact on the patient's quality of life (QOL). The standardization of AIBD outcome measures is pivotal to accurately monitor the patient and to pool results from randomized controlled trials for meta-analysis, and thereby provide knowledge of the optimal AIBD therapies. In the past decade, several AIBD severity outcome measures have been developed and validated. For pemphigus severity, the Pemphigus Disease Area Index (PDAI) developed by the International Pemphigus Definitions Group was shown to be the most superior, followed by the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) by the German group. For bullous pemphigoid severity, the Bullous Pemphigoid Disease Area Index (BPDAI) was shown to be an accurate and valid measure. To quantify the burden of AIBD and its treatments on QOL, the Autoimmune Bullous Disease Quality of Life (ABQOL) and the Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL) were also developed, validated, and are now being validated in multiple languages and cultures.
Collapse
Affiliation(s)
- Cathy Y Zhao
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
| | | |
Collapse
|
19
|
Kamiya K, Aoyama Y, Nishio E, Horio A, Tokura Y. Management of erythematous skin lesions in bullous pemphigoid associated with atopic dermatitis. J Dermatol 2016; 43:1102-3. [PMID: 26946485 DOI: 10.1111/1346-8138.13330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
MESH Headings
- Administration, Oral
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/therapeutic use
- Autoantigens/immunology
- Chemokine CCL17/blood
- Complement C3/metabolism
- Dermatitis, Atopic/complications
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/immunology
- Dermatitis, Atopic/pathology
- Enzyme-Linked Immunosorbent Assay
- Female
- Fluorescent Antibody Technique, Direct
- Glucocorticoids/administration & dosage
- Glucocorticoids/therapeutic use
- Humans
- Immunoglobulin E/blood
- Immunoglobulin E/metabolism
- Immunoglobulin G/blood
- Immunoglobulin G/metabolism
- Middle Aged
- Minocycline/administration & dosage
- Minocycline/therapeutic use
- Non-Fibrillar Collagens/immunology
- Pemphigoid, Bullous/complications
- Pemphigoid, Bullous/drug therapy
- Pemphigoid, Bullous/immunology
- Pemphigoid, Bullous/pathology
- Prednisolone/administration & dosage
- Prednisolone/therapeutic use
- Severity of Illness Index
- Skin/pathology
- Collagen Type XVII
Collapse
Affiliation(s)
- Koji Kamiya
- Department of Dermatology, Toyokawa City Hospital, Toyokawa, Japan
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yumi Aoyama
- Department of Dermatology, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan
| | - Eiichi Nishio
- Department of Dermatology, Toyokawa City Hospital, Toyokawa, Japan
| | - Ai Horio
- Department of Dermatology, Toyokawa City Hospital, Toyokawa, Japan
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
20
|
Abstract
Bullous pemphigoid (BP) is the commonest subtype of autoimmune blistering disease in most countries of the world. It occurs most frequently in elderly patients and is characterised clinically by large, tense blisters in the skin preceded by urticarial plaques and pruritus. Immunopathologically, it is characterised by autoantibodies directed against the 180 kD antigen (BP180) and the 230 kD antigen (BP230). New knowledge regarding BP is being continually uncovered. This article reviews the recent advances in BP, including newer diagnostic tests, standardised outcome measures and emerging therapeutic options, as well as the evidence supporting their use.
Collapse
Affiliation(s)
- Cathy Y Zhao
- Department of Dermatology, St George Hospital, Kogarah, Sydney, NSW 2217, Australia; University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Kogarah, Sydney, NSW 2217, Australia; University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| |
Collapse
|
21
|
Phoon YW, Fook-Chong SM, Koh HY, Thirumoorthy T, Pang SM, Lee HY. Infectious complications in bullous pemphigoid: An analysis of risk factors. J Am Acad Dermatol 2015; 72:834-9. [DOI: 10.1016/j.jaad.2015.01.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/07/2015] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
|
22
|
Kamiya K, Aoyama Y, Noda K, Miyake T, Yamaguchi M, Hamada T, Tokura Y, Iwatsuki K. Possible correlation of IgE autoantibody to BP180 with disease activity in bullous pemphigoid. J Dermatol Sci 2015; 78:77-9. [PMID: 25771164 DOI: 10.1016/j.jdermsci.2015.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/12/2015] [Accepted: 02/18/2015] [Indexed: 11/23/2022]
Affiliation(s)
- Koji Kamiya
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Yumi Aoyama
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuyo Noda
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Miyake
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mari Yamaguchi
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshihisa Hamada
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keiji Iwatsuki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|