Effect and length of doxycycline administration in elderly patients with bullous pemphigoid

BACKGROUND: Bullous pemphigoid (BP) is the most common autoimmune blistering disease and primarily affects the elderly. Systemic corticosteroids and immunosuppressive drugs are the standard treatment, but side effects often restrict their use. Doxycycline has been proposed as an alternative, but there is limited long-term, real-world data on its efficacy and tolerability. We aimed to evaluate the effectiveness and length of doxycycline treatment in BP patients. PATIENTS AND METHODS: This retrospective, single-center study analyzed data from patients with a confirmed BP diagnosis treated with doxycycline. The comprehensive dataset included information on disease severity, concomitant therapies, and treatment response. Treatment duration was analyzed using the Kaplan-Meier method. RESULTS: The cohort comprised 102 patients with a mean age of 79 (range 51-95) years. A clinical response (an improvement of 1 or 2 on the PGA score, which ranges from 2 to -2) was observed in 85 patients (83.3 %), many of whom received combination therapy with other drugs (67.7 %). The median length of doxycycline treatment was 122.7 weeks. Adverse events, mainly of gastrointestinal origin, were rare, non-serious and manageable. CONCLUSIONS: Doxycycline proved to be an effective and well-tolerated long-term treatment for elderly patients with BP, when used either as monotherapy or in combination.