490 Adjuvant immunoadsorption in severe and/or refractory bullous pemphigoid

Immunoadsorption (IA) is increasingly used for the initial adjuvant treatment of severe pemphigus. Since the pathogenic effect of anti-BP180 antibodies in bullous pemphigoid (BP) has clearly been shown, IA appears to be rational therapeutic approach also in BP. At present, information on the use of IA in BP is limited to individual case reports and a small case series. Here, we report on 20 patients with severe or relapsed BP (13 female, 7 male, mean age 78.6 years; range 56 to 94 years) treated by adjuvant IA on 3 consecutive days in addition to tapering doses of oral prednisolone, dapsone, and lesional topical clobetasol propionate 0.05% ointment. Fifteen patients had been pretreated with topical and systemic glucocorticosteroids and immunosuppressants without satisfying success. We observed a rapid clinical response (complete remission on therapy) in 8 patients (42%) within 4 weeks after initiation of the IA protocol. Serum anti-BP180 autoantibody levels decreased by 73% and 87% within 1 and 3 months, respectively. Reversible anaemia in 8 patients was the most common adverse event, most likely attributed to concomitant dapsone. Severe adverse events occurred in 3 patients: one patient developed a cardiac decompensation after the 3rd day of IA, one patient an apoplex after the 2nd day of IA and one patient suffered from a sigma perforation several weeks after IA. This case series shows that the application of IA in patients with severe and/or therapy-refractory BP, in addition to a standard therapy regimen, is a feasible treatment option also in this elderly patient population.