Background.  Corticosteroids, especially prednisolone or prednisone, are the most commonly used drugs for the treatment of bullous pemphigoid (BP). However, the appropriate initial effective prednisolone dose has not been established. Recently, a highly sensitive and specific ELISA for detection of autoantibodies to the non-collagenous extracellular domain (NC16A) of the 180 kDa transmembrane hemidesmosome component [bullous pemphigoid (BP)180] was developed, and the titre of anti-BP180 antibody was found to be closely related to disease activity.

Aim.  To investigate the relationship between anti-BP180 antibody titre and effective prednisolone dose alone or in conjunction with other immunosuppressants.

Methods.  Anti-BP180 antibody titres were measured by ELISA for the NC16A domain of BP180 in the sera of patients with BP (n = 42) at the start of treatment. The effective prednisolone dose was calculated from the patients’ records.

Results.  Higher anti-BP180 antibody titres correlated with a higher effective prednisolone dose. In particular, patients with antibody titres > 200 required a significantly higher effective prednisolone dose than did those with antibody titres ≤ 200.

Conclusions.  A higher effective prednisolone dose may be necessary for patients who have both a high titre of anti-BP180 antibody and severe clinical disease.