Can Methotrexate Be Employed as Monotherapy for Bullous Pemphigoid? Analysis of Efficiency and Tolerance of Methotrexate Treatment in Patients with Bullous Pemphigoid

Abstract

The European Academy of Dermatology and Venerology (EADV) consensus states that the treatment of choice for bullous pemphigoid is systemic glucocorticosteroid therapy. Bearing in mind that long-term steroid therapy is associated with numerous side effects, an effective and safer treatment regimen for these patients is still being sought. A retrospective analysis was performed of the medical reports of patients with diagnosed bullous pemphigoid. The study included 40 patients with moderate or severe disease, and who had continued ambulatory treatment for at least six months. The patients were divided into two groups: one treated with methotrexate in monotherapy, or with combined methotrexate and systemic steroid therapy. A slightly better survival rate was noted in the methotrexate group. No significant differences were observed between the groups in time to achieve clinical remission. The combination therapy group demonstrated more frequent disease recurrence and exacerbations during treatment, and a higher mortality rate. None of the patients in either group presented with severe side effects related to methotrexate treatment. The treatment of bullous pemphigoid with methotrexate in monotherapy is an effective and safe therapeutic method for elderly patients.

Keywords: bullous pemphigoid; glucocorticosteroids; immunosupressive therapy; methotrexate.

Figure 1

Comparison of Group 1 and Group 2 with regard to (A) age, (B) survival rate, (C) clinical remission, (D) minimal dose. MTX—Methotrexate, GKS—glucocorticosteroids. (A,D) White bar—group 1, shadow bar—group 2. The results of semiquantitative analysis are expressed as the mean ± standard deviation. The level of significance is defined where p < 0.05. (B,C) White and shadow bar—presented feature in the group in %.

Figure 2

Comparison between Group 1 and Group 2 with regard to (A) the presence of lesions on mucosa membranes, (B) well tolerated MTX therapy, (C) recurrence of the disease, (D) exacerbations during treatment. MTX—Methotrexate, GKS—glucocorticosteroids. The results of semiquantitative analysis are expressed as the mean ± standard deviation. The level of significance is defined where p < 0.05. White and shadow bar—presented feature in the group in %.