Effectiveness and safety of methylprednisolone combination with abrocitinib compared to methylprednisolone combination with azathioprine in bullous pemphigoid: a retrospective study

Bullous pemphigoid (BP) is an autoimmune skin disorder involving Th2-related inflammation. Abrocitinib is a JAK1 inhibitor and a promising therapeutic option for BP as it can effectively attenuate Th2-associated inflammation. This study compared the efficacy and safety of methylprednisolone combined with abrocitinib (abrocitinib group) versus methylprednisolone combined with azathioprine (conventional group) in BP treatment. The median time for disease control and achievement of minimal therapy in the abrocitinib group was notably reduced compared with those in the conventional group [7 vs. 11 days (p = 0.0006) and 100 versus days (p < 0.0001), respectively]. Additionally, the median cumulative methylprednisolone amount (at the time of achieving minimal therapy) in the abrocitinib group was remarkably reduced compared to that in the conventional group (1568 versus 2170 mg; p < 0.0001). Moreover, the abrocitinib group exhibited a more rapid decrease in Bullous Pemphigoid Disease Area Index (BPDAI) and itching Numeric Rating Scale (NRS) scores. At week 36, 11 patients (52.4%) in the abrocitinib group achieved complete remission (CR) off therapy, which was significantly higher than 2 patients (9.1%) in the conventional group (p = 0.003). There were no serious abrocitinib-associated adverse effects. Methylprednisolone combined with abrocitinib appeared more effective than methylprednisolone combined with azathioprine in controlling disease progression and tapering corticosteroids in BP patients.