The most important questions
- How effective, safe and cost-efficient is rituximab (or similar biologics) in BP/PV/MMP compared to standard steroid/immunosuppressant use, when should it be started and should it be a 1st line treatment?
- Are outcomes for patients with BP/MMP/PV better if treatment is started earlier and with 'stronger' treatments, such as an immunosuppressant or biologic, rather than escalating from 'milder' treatments if they do not work?
- How should persistent mouth lesions be best treated in pemphigus and pemphigoid?
- What is the best treatment for preventing and repairing scarring in MMP (medical and surgical)?
- Is it possible to identify drugs that block the specific immune pathways for BP/MMP/PV rather than treat them with broad immunosuppressive drugs?
- What are the risks and benefits of the different tablet and injection treatments used to treat BP/MMP/PV? (such as azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide, chlorambucil, nicotinamide, dapsone, intravenous immunoglobulin, plasmapheresis)
- What factors predict relapses in BP/MMP/PV, how can the risk of relapse be reduced and how are relapses best treated?
- What is the best/most effective dose to prescribe for steroid tablets in BP/MMP/PV including the starting dose, when and how quickly to reduce the dose, and when to stop?
- Can we predict the response to treatment in BP/MMP/PV and what factors affect this?
- What is the best way to treat skin wounds in BP/MMP/PV including how should blisters/ erosions be best washed and managed and does treatment vary according to body site?
The following questions were also discussed and put in order of priority at the workshop:
- How effective and safe are topical treatments for different parts of the body in BP/MMP/PV, and which are the most effective for each part?
- What is the best management of pain at all stages of disease in BP/MMP/PV, whilst minimising the side effects of treatments for pain?
- What are the risks/side effects and benefits of the different forms of steroid tablets and injections and how can the side-effects be best monitored and managed?
- In patients with BP/MMP/PV, how long does it take to achieve remission, how is it best maintained, how long does it last and what is the likelihood of relapse?
- How long should tablet treatments for BP/MMP/PV be continued before starting to reduce the dose?
- What is the best diet to support patients with BP/MMP/PV? Are there any foods to avoid or take? Do dietary supplements and/or probiotics improve or trigger BP/MMP/PV?
- How can itching be best relieved in BP/MMP/PV?