An 80-year-old woman with extensive bullous pemphigoid has heart failure and type 2 diabetes. Her physician wishes to avoid systemic corticosteroids. Based on randomised trial evidence, which oral agent is an acceptable steroid-sparing alternative for initial control of moderate disease?

• A Doxycycline 200 mg daily ✓
• B Methotrexate 15 mg weekly
• C Azathioprine 2 mg/kg/day
• D Colchicine 0.5 mg twice daily

Explanation

The BLISTER randomised trial showed that doxycycline 200 mg daily was non-inferior to prednisolone for maintaining disease control in bullous pemphigoid at 6 weeks, with fewer serious adverse events, making it attractive in elderly comorbid patients. Its action is thought to be anti-inflammatory through inhibition of matrix metalloproteinases and leukocyte function. Azathioprine and methotrexate are used as steroid-sparing agents but were not the tested comparator in that trial.

Reference: Rook's Textbook of Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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