Oren-Shabtai Meital, Kremer Noa, Lapidoth Moshe, Sharon Eran, Atzmony Lihi, Nosrati Adi, Hodak Emmilia, Mimouni Daniel, Levi Assi
Division of Dermatology, Rabin Medical Center, 39 Ze'ev Jabotinsky St., 4941492, Petah Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Drugs Aging. 2021 Feb;38(2):125-136. doi: 10.1007/s40266-020-00823-5. Epub 2020 Nov 24.
Bullous pemphigoid commonly affects older adults and has a detrimental effect on both quality of life and longevity. Systemic corticosteroids, the mainstay of therapy, may cause significant adverse effects, especially in older patients. Therefore, safer therapeutic options are being sought.
The objective of this article was to systematically review the published evidence on the efficacy and safety of different treatment modalities for bullous pemphigoid in older patients.
We performed a systematic review of all publications until May 2020 in PubMed, Google Scholar, and the ongoing trials registry of the US National Institutes of Health databases evaluating the efficacy and safety of bullous pemphigoid treatments in patients aged older than 80 years. The primary outcome was complete response. The secondary outcomes were partial response, complete remission on minimal therapy or during tapering, recurrence, adverse events, and mortality.
Twenty-eight publications were included: 2 randomized controlled trials, 5 prospective cohort studies, 10 retrospective cohort studies, and 11 case series, with a total of 153 older patients. The overall complete response rate was 31%. Topical corticosteroids had the highest complete response rate (55%) with a low side-effect profile. Biologics (omalizumab and rituximab) were effective in achieving complete remission on minimal therapy (29%) without recurrence, although rituximab was associated with a relatively high mortality rate (29%).
Current data suggest that topical corticosteroids are effective and safe and should remain the first line of treatment for bullous pemphigoid in older adults. However, their application is difficult and requires a high-functioning patient, third-party assistance, or a relatively mild disease. Biological agents are effective but warrant meticulous patient selection owing to the relatively high mortality rate associated with rituximab.
PROSPERO registration number CRD42020186686.
大疱性类天疱疮常见于老年人，对生活质量和寿命均有不利影响。全身用糖皮质激素作为主要治疗手段，可能会引起显著的不良反应，尤其是在老年患者中。因此，人们正在寻找更安全的治疗选择。
本文的目的是系统回顾已发表的关于老年患者大疱性类天疱疮不同治疗方式的疗效和安全性的证据。
我们对截至2020年5月在PubMed、谷歌学术以及美国国立卫生研究院数据库的正在进行的试验注册库中发表的所有评估80岁以上患者大疱性类天疱疮治疗疗效和安全性的文献进行了系统回顾。主要结局是完全缓解。次要结局包括部分缓解、在最小治疗量或减药期间完全缓解、复发、不良事件和死亡率。
纳入28篇文献：2项随机对照试验、5项前瞻性队列研究、10项回顾性队列研究和11个病例系列，共153例老年患者。总体完全缓解率为31%。外用糖皮质激素的完全缓解率最高（55%），且副作用小。生物制剂（奥马珠单抗和利妥昔单抗）在最小治疗量时有效实现完全缓解（29%）且无复发，尽管利妥昔单抗的死亡率相对较高（29%）。
目前数据表明，外用糖皮质激素有效且安全，应仍是老年人大疱性类天疱疮的一线治疗方法。然而，其应用困难，需要患者功能良好、第三方协助或病情相对较轻。生物制剂有效，但由于利妥昔单抗相关死亡率相对较高，需要谨慎选择患者。
PROSPERO注册号CRD42020186686
