Bullous pemphigoid: A case series with emphasis on long-term remission off therapy

Background: Bullous pemphigoid (BP) is the most common blistering autoimmune skin disease. Combination methotrexate (MTX) and prednisone therapy is an effective short-term treatment for BP. Objective: To determine the average length and frequency with which MTX and prednisone combination therapy leads to long-term remission off therapy. Methods: A retrospective chart review of 16 of our patients with BP was conducted. Patients were treated with the combination regimen of MTX and prednisone, followed by us for at least 1 year, and had long-term follow-up data. Results: The average length of time from initiating MTX and prednisone therapy to complete disease control was 3.8 months. Eight of 16 patients were in remission off BP therapy with combination MTX and prednisone therapy. The average length of treatment in this subgroup was 25.3 months and patients were followed for a mean of 5.5 years since initiating therapy. Three additional patients were in remission (with a mean treatment time short of the 25.3 month average) undergoing tapering of BP therapy. Conclusions: Two year MTX and prednisone combination therapy is a safe, inexpensive, and effective treatment for BP that can result in long-term remission off therapy.