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Role of Methotrexate in the Treatment of Bullous Pemphigoid in the Elderly

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Abstract

Bullous pemphigoid (BP) is an autoimmune blistering disease that commonly occurs in the elderly. Immunosuppressive medications are effective at controlling the disease in the majority of cases. Mortality can occur as a consequence of severe disease or as a result of the therapies that are frequently employed as treatment. Commonly employed therapies include systemic corticosteroids, azathioprine and mycophenolate mofetil. In a small subset of patients, these first- and second-line therapies do not control disease or are not tolerated by the patients. Optional therapies include nicotinamide (niacinamide), tetracycline, intravenous immunoglobulin, cyclophosphamide, dapsone and methotrexate. The majority of BP patients are elderly, and several considerations need to be taken into account before a specific therapy is chosen. Methotrexate provides several advantages in the elderly population in terms of practicality, cost and tolerability. Several retrospective and prospective studies have evaluated its effectiveness in the treatment of BP in the elderly population. The results of these studies indicate that methotrexate is an effective therapy for BP and is a reasonable option for treatment in the elderly population, although maybe not as a first- or second-line therapy.

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References

  1. Stanley JR, Hawley-Nelson P, Yuspa SH, et al. Characterization of bullous pemphigoid antigen: a unique basement membrane protein of stratified squamous epithelia. Cell 1981; 24(3): 897–903

    Article  PubMed  CAS  Google Scholar 

  2. Labib RS, Anhalt GJ, Patel HP, et al. Molecular heterogeneity of the bullous pemphigoid antigens as detected by immunoblotting. J Immunol 1986; 136(4): 1231–5

    PubMed  CAS  Google Scholar 

  3. Liu Z, Giudice GJ, Swartz SJ, et al. The role of complement in experimental bullous pemphigoid. J Clin Invest 1995; 95(4): 1539–44

    Article  PubMed  CAS  Google Scholar 

  4. Korman NJ. Bullous pemphigoid: the latest in diagnosis, prognosis, and therapy. Arch Dermatol 1998; 134(9): 1137–41

    Article  PubMed  CAS  Google Scholar 

  5. Bernard P, Vaillant L, Labeille B, et al. Incidence and distribution of subepidermal autoimmune bullous skin diseases in three French regions: Bullous Diseases French Study Group. Arch Dermatol 1995; 131(1): 48–52

    Article  PubMed  CAS  Google Scholar 

  6. Zillikens D, Wever S, Roth A, et al. Incidence of autoimmune subepidermal blistering dermatoses in a region of central Germany. Arch Dermatol 1995; 131(8): 957–8

    Article  PubMed  CAS  Google Scholar 

  7. Adam BA. Bullous diseases in Malaysia: epidemiology and natural history. Int J Dermatol 1992; 31(1): 42–5

    Article  PubMed  CAS  Google Scholar 

  8. Jin P, Shao C, Ye G. Chronic bullous dermatoses in China. Int J Dermatol 1993; 32(2): 89–92

    Article  PubMed  CAS  Google Scholar 

  9. Joly P, Benichou J, Lok C, et al. Prediction of survival for patients with bullous pemphigoid: a prospective study. Arch Dermatol 2005; 141(6): 691–8

    Article  PubMed  Google Scholar 

  10. Serwin AB, Bokiniec E, Piascik M, et al. Epidemiological and clinical analysis of pemphigoid patients in northeastern Poland in 2000–2005. Med Sci Monit 2007; 13(8): CR360–4

    PubMed  Google Scholar 

  11. Nanda A, Al-Saeid K, Al-Sabah H, et al. Clinicoepidemiological features and course of 43 cases of bullous pemphigoid in Kuwait. Clin Exp Dermatol 2006; 31(3): 339–42

    Article  PubMed  CAS  Google Scholar 

  12. Haynes L, Swain SL, Cambier J, et al. Aging and immune function: summary of a workshop held at Trudeau Institute, Saranac Lake, NY. Mech Ageing Dev 2005; 126(6–7): 822–5

    Article  PubMed  CAS  Google Scholar 

  13. Joly P, Roujeau JC, Benichou J, et al. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med 2002; 346(5): 321–7

    Article  PubMed  CAS  Google Scholar 

  14. Patton T, Korman NJ. Bullous pemphigoid treatment review. Expert Opin Pharmacother 2006; 7(17): 2403–11

    Article  PubMed  CAS  Google Scholar 

  15. Khumalo N, Kirtschig G, Middleton P, et al. Interventions for bullous pemphigoid. Cochrane Database Syst Rev 2005; (3): CD002292

    Google Scholar 

  16. Menter MA, Krueger GC, Feldman SR, et al. Psoriasis treatment 2003 at the new millennium: position paper on behalf of the authors. J Am Acad Dermatol 2003; 49 (2 Suppl.): S39–43

    Article  PubMed  Google Scholar 

  17. Baggott JE, Morgan SL, TS Ha, et al. Antifolates in rheumatoid arthritis: a hypothetical mechanism of action. Clin Exp Rheumatol 1993 Mar–Apr; 11Suppl. 8: S101–5

    PubMed  Google Scholar 

  18. Kazlow Stern D, Tripp JM, Ho VC, et al. The use of systemic immune moderators in dermatology: an update. Dermatol Clin 2005; 23(2): 259–300

    Article  PubMed  Google Scholar 

  19. Bangert CA, Costner MI. Methotrexate in dermatology. Dermatol Ther 2007 Jul–Aug; 20(4): 216–8

    Article  PubMed  Google Scholar 

  20. Downham 2nd TF, Chapel TA. Bullous pemphigoid: therapy in patients with and without diabetes mellitus. Arch Dermatol 1978; 114(11): 1639–42

    Article  PubMed  Google Scholar 

  21. Paul MA, Jorizzo JL, Fleischer Jr AB, et al. Low-dose methotrexate treatment in elderly patients with bullous pemphigoid. J Am Acad Dermatol 1994; 31(4): 620–5

    Article  PubMed  CAS  Google Scholar 

  22. Bohm I, Bauer R. Treatment of bullous pemphigoid with low-dose methotrexate. Hautarzt 1997; 48(12): 910–4

    Article  PubMed  CAS  Google Scholar 

  23. Heilborn JD, Stahle-Backdahl M, Albertioni F, et al. Low-dose oral pulse methotrexate as monotherapy in elderly patients with bullous pemphigoid. J Am Acad Dermatol 1999; 40 (5 Pt 1): 741–9

    Article  PubMed  CAS  Google Scholar 

  24. Dereure O, Bessis D, Guillot B, et al. Treatment of bullous pemphigoid by low-dose methotrexate associated with short-term potent topical steroids: an open prospective study of 18 cases. Arch Dermatol 2002; 138(9): 1255–6

    Article  PubMed  Google Scholar 

  25. Bara C, Maillard H, Briand N, et al. Methotrexate for bullous pemphigoid: preliminary study. Arch Dermatol 2003; 139(11): 1506–7

    Article  PubMed  Google Scholar 

  26. Lovell DJ, Zaoutis TE, Sullivan K. Immunosuppressants, infection, and inflammation. Clin Immunol 2004; 113(2): 137–9

    Article  PubMed  CAS  Google Scholar 

  27. Boey O, Van Hooland S, Woestenburg A, et al. Methotrexate should not be used for patients with end-stage kidney disease. Acta Clin Belg 2006; 61(4): 166–9

    PubMed  CAS  Google Scholar 

  28. Roenigk Jr HH, Auerbach R, Maibach H, et al. Methotrexate in psoriasis: consensus conference. J Am Acad Dermatol 1998 Mar; 38(3): 478–85

    Article  PubMed  Google Scholar 

  29. Grills C, Burge S. Methotrexate: improving safety profile. Australas J Dermatol 2006; 47(3): 178–81

    Article  PubMed  Google Scholar 

  30. Strober BE, Menon K. Folate supplementation during methotrexate therapy for patients with psoriasis. J Am Acad Dermatol 2005; 53(4): 652–9

    Article  PubMed  Google Scholar 

  31. Rheumatrex® (methotrexate) [package insert]. Cranbury (NJ): STADA Pharmaceuticals, Inc., 2003

  32. DeHoratio DM, Sperber BR, Werth VP. Glucocorticoids in the treatment of bullous diseases. Dermatologic Ther 2002; 15(4): 298–310

    Article  Google Scholar 

  33. Wise M, Callen JP. Azathioprine: a guide for the management of dermatology patients. Dermatol Ther 2007 Jul–Aug; 20(4): 206–15

    Article  PubMed  Google Scholar 

  34. Sami N, Ali S, KC Bhol, et al. Influence of intravenous immunoglobulin therapy on autoantibody titres to BP Ag1 and BP Ag2 in patients with bullous pemphigoid. J Eur Acad Dermatol Venereol 2003 Nov; 17(6): 641–5

    Article  PubMed  CAS  Google Scholar 

  35. Schmidt E, Seitz CS, Benoit S, et al. Rituximab in autoimmune bullous diseases: mixed responses and adverse effects. Br J Dermatol 2007; 156(2): 352–6

    Article  PubMed  CAS  Google Scholar 

  36. Grattan CE. Evidence of an association between bullous pemphigoid and psoriasis. Br J Dermatol 1985; 113(3): 281–3

    Article  PubMed  CAS  Google Scholar 

  37. Person JR, Rogers 3rd RS. Bullous pemphigoid and psoriasis: does subclinical bullous pemphigoid exist? Br J Dermatol 1976; 95(5): 535–40

    Article  PubMed  CAS  Google Scholar 

  38. Stuttgen G, Bockendahl H, Remy W, et al. Psoriasis and bullous dermatoses. Hautarzt 1978; 29(3): 134–40

    PubMed  CAS  Google Scholar 

  39. Koerber Jr WA, Price NM, Watson W. Coexistent psoriasis and bullous pemphigoid: a report of six cases. Arch Dermatol 1978; 114(11): 1643–6

    Article  PubMed  Google Scholar 

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Acknowledgements

No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Department of Dermatology, University of Pittsburgh, 3601 Fifth Avenue, Fifth Floor, Pittsburgh, Pennsylvania, 15217, USA

    Timothy Patton

  2. Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA

    Neil Korman

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  1. Timothy Patton
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  2. Neil Korman
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Correspondence to Timothy Patton.

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Patton, T., Korman, N. Role of Methotrexate in the Treatment of Bullous Pemphigoid in the Elderly. Drugs Aging 25, 623–629 (2008). https://doi.org/10.2165/00002512-200825080-00001

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