Patient selection: bullous pemphigoid treated with corticosteroids
Outcome: relapse in the 12 months following clinical remission (most of which occurred during the first 3 months after stopping therapy)
Criteria for remission:
(1) absence of blisters, erosions and pruritic erythematous eruptions
(2) for at least 3 months
Criteria for relapse:
(1) appearance of new bullae daily for several consecutive days
(2) reappearance of pruritis and erythema
Findings on day 0 (day corticosteroids stopped) associated with relapse:
(1) positive direct immunofluorescence (performed on 4 mm punch biopsy from flexural aspect of arm or thigh)
(2) high titer (>= 27 IU/mL) ELISA score for autoantibodies to BP180
where:
• 27 IU on the ELISA assay was 3 times the upper limit of the normal reference range.
• The ELISA assay target was the NC-16A domain of BP180 and the assay was from MBL Co, Ltd in Nagoya, Japan.
Older age was associated with relapse, with mean age for those who relapsed being 82.2 (+/- 7.8) years versus 77 (+/- 10.1) years for those who continued in remission.
