How to Apply the New Data from RCT to Clinical Management of Bullous Pemphigoid

In this presentation directed by Professor Jolie, the application of data from recent randomized clinical trials (RCTs) on bullous pemphigoid (BP) is discussed. Key trials reviewed include studies on dupilumab, methotrexate, and doxycycline for managing BP. The LIBERTY trial demonstrated that dupilumab, compared to placebo, allowed for a tapering of corticosteroids while achieving complete remission in 20% of cases, though concerns were raised regarding the high relapse rate in the placebo group and the lack of a standard care comparator. Retrospective studies suggested better outcomes when dupilumab is used alongside corticosteroids. Methotrexate was shown to be effective, presenting a non-inferiority to standard corticosteroid treatment and a lower relapse rate. In clinical practice, methotrexate is recommended as an adjunct therapy, ideally combined with corticosteroids to enhance effectiveness and reduce reliance on long-term steroid use. The BLISTER trial compared doxycycline and corticosteroids, highlighting limited efficacy and high reliance on corticosteroids. Overall, the speaker recommended prioritizing methotrexate, followed by dupilumab, for BP management. Doxycycline may be considered only for less severe cases or in patients unable to take other treatments. The discussion emphasizes the need for careful patient selection and monitoring, particularly with methotrexate, and notes that all three drugs do not permit the use of very low initial corticosteroid doses, which remains an unmet need.