064 Early Clinical Score Changes Predict Additional Treatment Necessity In Pemphigus/Pemphigoid

Current guidelines recommend that the disease severity and treatment efficacy should be evaluated with clinical scores in pemphigus/pemphigoid. PDAI in pemphigus and BPDAI in pemphigoid are widely used to determine whether additional second-line therapies (e.g., plasma change) should be considered if initial treatment is insufficient for disease control. To validate the utility of monitoring PDAI/BPDAI transitions, we retrospectively analysed 67 pemphigus and 47 pemphigoid patients who received the initial therapy in the dermatology department of an institute in Japan. We analysed PDAI/BPDAI score ratios of day7/ day0 and day14/ day0. In comparison between the groups of patients who needed additional therapies (Group B) or not (Group A), the ratios of day7/ day0 were significantly decreased in Group A compared to Group B: 0.548 vs 0.761 in PDAI, 0.565 vs 0.901 in BPDAI (erosion/blister: E/B), 0.350 vs 0.760 in BPDAI (urticaria/erythema: U/E), respectively (p<0.05). The PDAI and BPDAI (E/B) ratios of day14/ day0 were also significantly reduced in Group A compared to Group B, (0.250 vs 0.621 and 0.172 vs 0.607, respectively, p<0.05). We focused the analysis on severe cases because there was no significant difference in PDAI/BPDAI scores between Group A and B before the initial treatments. The PDAI, BPDAI (E/B) and BPDAI (U/E) ratios of day 7/day0 significantly reduced in Group A compared to Group B (0.556 vs. 0.781, 0.661 vs. 0.907 and 0.268 vs. 0.820, respectively, p<0.05). The PDAI and BPDAI (E/B) ratios of day14/ day0 were also significantly reduced in Group A compared to Group B (0.222 vs 0.641 and 0.256 vs 0.642, respectively, p<0.01). Our results indicate that PDAI/BPDAI transitions are possible early predictors for necessity of additional therapy during the initial treatment phase.