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Treatment of epidermolysis bullosa acquisita with intravenous immunoglobulin in patients non‐responsive to conventional therapy: clinical outcome and post‐treatment long‐term follow‐up
Author(s) -
Ahmed A.R.,
Gürcan H.M.
Publication year - 2012
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/j.1468-3083.2011.04205.x
Subject(s) - medicine , epidermolysis bullosa acquisita , discontinuation , mucocutaneous zone , epidermolysis bullosa , dapsone , prednisone , concomitant , antibody , incidence (geometry) , population , surgery , dermatology , bullous pemphigoid , disease , immunology , physics , environmental health , optics
Background Epidermolysis bullosa acquisita (EBA) is a chronic subepidermal blistering disease that is caused by antibodies binding to type VII collagen within anchoring fibrils. It is rare disease with an incidence of 0.25 cases per 1 000 000 population. Objective The objective of this study is to report the treatment outcomes with intravenous immunoglobulin (IVIg) therapy in 10 patients with severe and widespread EBA non‐responsive to conventional therapy. Methods Patients were treated according to a protocol published in a Consensus Statement to treat autoimmune mucocutaneous blistering diseases, including EBA with IVIg. A dose of 2 g/kg/cycle was used. Results Ten patients: four males and six females, all were North American Caucasian. The age at onset varied from 37 to 75 years (mean 57.4). A satisfactory clinical response was observed in all 10 patients. The patients received 16–31 cycles (mean 23.1) of IVIg over a period of 30–52 months (mean 38.8). Once IVIg was initiated, earlier drugs (prednisone, dapsone and others) were gradually withdrawn over a 5–9 month period (mean 7.2). Thereafter, IVIg was used as monotherapy. No serious side‐effects were observed. The follow‐up period since discontinuation of IVIg varied from 29 to 123 months (mean 53.9). During this follow‐up period, recurrence of disease was not observed. Conclusion The data suggest that IVIg can produce a long‐term sustained clinical remission in patients with EBA. In the patients, of this study concomitant therapy could be discontinued and IVIg was used as monotherapy.