Bullous pemphigoid (BP) is a widely recognized autoimmune blistering disease (AIBD) that causes a high incidence of morbidity and mortality. A recent study evaluated the available findings of randomized clinical trial (RCT) studies to update interventions for Bullous pemphigoid. 

It searched the literature using Cochrane Central Register of Clinical Trials, MEDLINE, Scopus and Web of Science from August 2010 to December 2020. 

The study included all RCTs done on adults and investigated the effectiveness of administered topical or systemic medications versus placebos or controls. It included three RCTs comprising 363 patients. One of the eligible studies was placebo-controlled. The included studies used various interventions like methylprednisolone plus azathioprine versus methylprednisolone plus dapsone, doxycycline versus prednisolone and intravenous immunoglobulin (IVIG). 

This study found that apart from their potential in disease control, dapsone and azathioprine have no difference, yet dapsone has a higher corticosteroid-sparing potential. The effect of doxycycline in short-term blister control is not inferior to prednisolone, although it has higher long-term safety. 

Thus, this study highlighted the potential role of dapsone as adjuvant therapy in treating BP with a relatively low mortality rate. Due to its long-term safety, doxycycline, combined with corticosteroids, is a good choice for the acute regulation of blisters. IVIG is perhaps a convenient medical therapy for patients resistant to steroid therapy. 

Further, large blinded RCTs are needed to investigate the efficiency and safety of various immunosuppressive drugs and tetracyclines for treating BP.

Source: Asilian A, Safaei H, Iraji F, et al. Interventions for bullous pemphigoid: an updated systematic review of randomized clinical trials. Med J Islam Repub Iran. 2021;35:111.