Efficacy and Safety of add-on Dapsone Versus add-on Methotrexate in Patients With Bullous Pemphigoid

NCT ID: NCT05984381

Last Updated: 2025-08-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

62 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-08-01

Study Completion Date

2025-04-01

Brief Summary

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Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder most commonly affecting the older population between 60-80 years old. The characteristic feature of BP is itchy patches associated with blisters and erosions. BP significantly affects the patient's quality of life as it causes physical discomfort with itchy patches, blisters, and erosions. Several pieces of evidence from previous studies showed that the production of autoantibodies against the hemidesmosomal anchoring proteins BP180 (Bullous Pemphigoid antigen (BPAG 2)) and BP230 (BPAG 1) is the most common cause for bullous pemphigoid.

Therapeutic latency, lack of efficacy in many patients, and adverse drug reactions are the primary concerns in the current bullous pemphigoid treatment paradigm, including high-dose steroid treatment. To overcome these treatment challenges, combination therapy with agents having a steroid-sparing effect like mycophenolate mofetil, cyclophosphamide, azathioprine, and Methotrexate are tested as an add-on to low-dose steroids. 8So other immunosuppressive agents with better safety profiles and more efficacy, like Dapsone and Methotrexate as an add-on to low-dose steroids, can be used.

Investigator's literature search found no randomized controlled trial with Dapsone versus Methotrexate as an add-on to first-line steroid has been conducted to compare the efficacy and safety in bullous pemphigoid patients. So, a randomized controlled trial has been planned to evaluate the safety and efficacy of add-on methotrexate versus Dapsone in bullous pemphigoid patients.

Detailed Description

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Conditions

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Bullous Pemphigoid

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

randomized, add-on, active-controlled, open-label, parallel-design clinical trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Prednisolone and Methotrexate (Control Arm)

prednisolone 0.75mg/kg/day (a maximum dose of 40mg at baseline) and Methotrexate 15 mg weekly for 16 weeks.

Group Type ACTIVE_COMPARATOR

Prednisolone

Intervention Type DRUG

prednisolone 0.75mg/kg/day (a maximum dose of 40mg at baseline) orally

Methotrexate

Intervention Type DRUG

Methotrexate 15 mg weekly

Prednisolone and Dapsone (Test Arm)

prednisolone 0.75mg/kg/day (a maximum dose of 40mg at baseline) and Dapsone 100 mg/day for 16 weeks

Group Type EXPERIMENTAL

Prednisolone

Intervention Type DRUG

prednisolone 0.75mg/kg/day (a maximum dose of 40mg at baseline) orally

Dapsone

Intervention Type DRUG

Dapsone 100 mg/day

Interventions

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Prednisolone

prednisolone 0.75mg/kg/day (a maximum dose of 40mg at baseline) orally

Intervention Type DRUG

Dapsone

Dapsone 100 mg/day

Intervention Type DRUG

Methotrexate

Methotrexate 15 mg weekly

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients aged ≥18 of either sex with the clinical diagnosis of Bullous pemphigoid.
* Patients with BPDAI score ≥ 20 (moderate and severe BP).
* Patients must have characteristic clinical features of bullous pemphigoid at the screening and baseline visits. (Urticaria, bullae, pruritis).
* Patients who are willing to give informed written consent.

Exclusion Criteria

* Patients on any steroid-sparing agents within one month of recruitment.
* Treatment with a systemic corticosteroid, sulfones, within the last week.
* Patients with Glucose 6 phosphate dehydrogenase deficiency.
* Decreased liver or renal function (creatinine \> 2.0mg/dl, total bilirubin \> 2.5 mg/dl).
* Severe acute infection, severe diabetes mellitus, untreated glaucoma, congenital or acquired immunodeficiency, active gastroduodenal ulcer, severe osteoporosis, severe cardiac disease (NYHA grade IV), MI in the last four weeks, severe schizophrenia or depression.
* Malignancies treated by cytotoxic or immunosuppressive medications.
* Anaemia (Hb \<9 gm/dl), leucopenia (\< 3 ×10 9 cells /L) or thrombocytopenia (\< 100 × 10 9 cells/ L), and H/O porphyria.
* Patient with a history of hypersensitivity to Methotrexate or Dapsone.
* Vaccination in the last two weeks.
* Patients with HIV, Hepatitis B, and C infection.
* Pregnancy and lactation, women of childbearing age without effective contraception.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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All India Institute of Medical Sciences, Bhubaneswar

OTHER

Sponsor Role lead

Responsible Party

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Dr. Monalisa Jena, M.D.

Additional Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Rituparna Maiti, MD

Role: STUDY_DIRECTOR

Professor

Locations

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AIIMS Bhubaneswar

Bhubaneswar, Odisha, India

Site Status

Countries

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India

References

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Lu L, Chen L, Xu Y, Liu A. Global incidence and prevalence of bullous pemphigoid: A systematic review and meta-analysis. J Cosmet Dermatol. 2022 Oct;21(10):4818-4835. doi: 10.1111/jocd.14797. Epub 2022 Feb 1.

Reference Type BACKGROUND
PMID: 35080093 (View on PubMed)

Chen X, Zhang Y, Luo Z, Wu Y, Niu T, Zheng J, Xie Y. Prognostic factors for mortality in bullous pemphigoid: A systematic review and meta-analysis. PLoS One. 2022 Apr 15;17(4):e0264705. doi: 10.1371/journal.pone.0264705. eCollection 2022.

Reference Type BACKGROUND
PMID: 35427358 (View on PubMed)

Genovese G, Di Zenzo G, Cozzani E, Berti E, Cugno M, Marzano AV. New Insights Into the Pathogenesis of Bullous Pemphigoid: 2019 Update. Front Immunol. 2019 Jul 2;10:1506. doi: 10.3389/fimmu.2019.01506. eCollection 2019.

Reference Type BACKGROUND
PMID: 31312206 (View on PubMed)

Patton T, Korman N. Role of methotrexate in the treatment of bullous pemphigoid in the elderly. Drugs Aging. 2008;25(8):623-9. doi: 10.2165/00002512-200825080-00001.

Reference Type BACKGROUND
PMID: 18665656 (View on PubMed)

Tirado-Sanchez A, Diaz-Molina V, Ponce-Olivera RM. Efficacy and safety of azathioprine and dapsone as an adjuvant in the treatment of bullous pemphigoid. Allergol Immunopathol (Madr). 2012 May-Jun;40(3):152-5. doi: 10.1016/j.aller.2010.12.009. Epub 2011 Apr 14.

Reference Type BACKGROUND
PMID: 21497011 (View on PubMed)

Sticherling M, Franke A, Aberer E, Glaser R, Hertl M, Pfeiffer C, Rzany B, Schneider S, Shimanovich I, Werfel T, Wilczek A, Zillikens D, Schmidt E. An open, multicentre, randomized clinical study in patients with bullous pemphigoid comparing methylprednisolone and azathioprine with methylprednisolone and dapsone. Br J Dermatol. 2017 Nov;177(5):1299-1305. doi: 10.1111/bjd.15649. Epub 2017 Oct 29.

Reference Type BACKGROUND
PMID: 28494097 (View on PubMed)

Rashid H, Lamberts A, Diercks GFH, Pas HH, Meijer JM, Bolling MC, Horvath B. Oral Lesions in Autoimmune Bullous Diseases: An Overview of Clinical Characteristics and Diagnostic Algorithm. Am J Clin Dermatol. 2019 Dec;20(6):847-861. doi: 10.1007/s40257-019-00461-7.

Reference Type BACKGROUND
PMID: 31313078 (View on PubMed)

Reunala T, Salmi TT, Hervonen K. Dermatitis herpetiformis: pathognomonic transglutaminase IgA deposits in the skin and excellent prognosis on a gluten-free diet. Acta Derm Venereol. 2015 Nov;95(8):917-22. doi: 10.2340/00015555-2162.

Reference Type BACKGROUND
PMID: 26059085 (View on PubMed)

Other Identifiers

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AIIMS BBSR/PG Thesis/2023-24

Identifier Type: -

Identifier Source: org_study_id

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