Plasmapheresis as a steroid saving procedure in bullous pemphigoid

Background Bullous pemphigoid is an immunobullous disease affecting predomi nantly older patients. In severe cases, high-dose corticosteroids and/or ot her immunosuppressants are often needed long term to control the disease. T hese can be associated with serious side-effects in this patient population . Objective To evaluate the benefit of plasmapheresis as a steroid saving age nt in a cohort of 10 patients. Results Plasmapheresis was effective as a steroid saving therapy. All patie nts went into remission with a lower daily dosage of oral prednisone at 3 a nd 6 months postplasmapheresis. Two patients had side-effects from therapy that, while significant, did not interfere with long-term improvement in th eir disease. Eight patients had circulating immunoglobulin G (IgG) antibodi es reactive with bullous pemphigoid antigen 1, and three of these had circu lating antibodies reactive with bullous pemphigoid antigen 2 on Western imm unoblot. Conclusions Plasmapheresis was an effective steroid sparing therapy in thes e patients. Due to its high cost and potential morbidity, plasmapheresis sh ould not be recommended as routine therapy for bullous pemphigoid, but it i s a useful adjunct in resistant cases.