ClinicalTrials.gg
CompletedNCT05984381Updated Aug 14, 2025

Efficacy and Safety of add-on Dapsone Versus add-on Methotrexate in Patients With Bullous Pemphigoid

A Phase 4 interventional study of Prednisolone and Dapsone in Bullous Pemphigoid, sponsored by All India Institute of Medical Sciences, Bhubaneswar. Completed at 1 site in India. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-08-14.

Sponsored by All India Institute of Medical Sciences, Bhubaneswar · Phase 4, Interventional, and Treatment

Phase
Phase 4
Study type
Interventional
Enrollment
62
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder most commonly affecting the older population between 60-80 years old. The characteristic feature of BP is itchy patches associated with blisters and erosions. BP significantly affects the patient's quality of life as it causes physical discomfort with itchy patches, blisters, and erosions. Several pieces of evidence from previous studies showed that the production of autoantibodies against the hemidesmosomal anchoring proteins BP180 (Bullous Pemphigoid antigen (BPAG 2)) and BP230 (BPAG 1) is the most common cause for bullous pemphigoid.

Therapeutic latency, lack of efficacy in many patients, and adverse drug reactions are the primary concerns in the current bullous pemphigoid treatment paradigm, including high-dose steroid treatment. To overcome these treatment challenges, combination therapy with agents having a steroid-sparing effect like mycophenolate mofetil, cyclophosphamide, azathioprine, and Methotrexate are tested as an add-on to low-dose steroids. 8So other immunosuppressive agents with better safety profiles and more efficacy, like Dapsone and Methotrexate as an add-on to low-dose steroids, can be used.

Investigator's literature search found no randomized controlled trial with Dapsone versus Methotrexate as an add-on to first-line steroid has been conducted to compare the efficacy and safety in bullous pemphigoid patients. So, a randomized controlled trial has been planned to evaluate the safety and efficacy of add-on methotrexate versus Dapsone in bullous pemphigoid patients.

02

Conditions studied

  • Bullous Pemphigoid

Keywords

  • Bullous pemphigoid
  • Methotrexate
  • Dapsone
  • BP180
  • Blister
  • Erosions
03

In context

Pemphigoid, Bullous

64 studies on the registry are indexed under Pemphigoid, Bullous; 8 are open to participants now.

This study's enrollment of 62 is above the median of 30 across 39 interventional studies indexed under Pemphigoid, Bullous.

Browse Pemphigoid, Bullous studies →

Lead sponsor

All India Institute of Medical Sciences, Bhubaneswar is the lead sponsor of 59 studies on the registry; 25 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Patients aged ≥18 of either sex with the clinical diagnosis of Bullous pemphigoid.
  • Patients with BPDAI score ≥ 20 (moderate and severe BP).
  • Patients must have characteristic clinical features of bullous pemphigoid at the screening and baseline visits. (Urticaria, bullae, pruritis).
  • Patients who are willing to give informed written consent.

Exclusion criteria

Exclusion Criteria:

  • Patients on any -sparing agents within one month of recruitment.
  • Treatment with a systemic corticosteroid, sulfones, within the last week.
  • Patients with Glucose 6 phosphate dehydrogenase deficiency.
  • Decreased liver or renal function (creatinine > 2.0mg/dl, total > 2.5 mg/dl).
  • Severe acute infection, severe diabetes mellitus, untreated glaucoma, congenital or acquired immunodeficiency, active gastroduodenal ulcer, severe osteoporosis, severe cardiac disease ( grade IV), MI in the last four weeks, severe schizophrenia or depression.
  • treated by cytotoxic or medications.
  • Anaemia ( \<9 gm/dl), leucopenia (\< 3 ×10 9 cells /L) or thrombocytopenia (\< 100 × 10 9 cells/ L), and H/O porphyria.
  • Patient with a history of to Methotrexate or Dapsone.
  • Vaccination in the last two weeks.
  • Patients with , , and C infection.
  • Pregnancy and lactation, women of childbearing age without effective .
Terms in these criteria, in plain language(10)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

05

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
62 participants (actual)

Study arms

  • Active comparator
    Prednisolone and Methotrexate (Control Arm)

    prednisolone 0.75mg/kg/day (a maximum dose of 40mg at baseline) and Methotrexate 15 mg weekly for 16 weeks.

    Drug: Prednisolone · Drug: Methotrexate

  • Experimental
    Prednisolone and Dapsone (Test Arm)

    prednisolone 0.75mg/kg/day (a maximum dose of 40mg at baseline) and Dapsone 100 mg/day for 16 weeks

    Drug: Prednisolone · Drug: Dapsone

Interventions

  • prednisolone 0.75mg/kg/day (a maximum dose of 40mg at baseline) orally

  • Dapsone 100 mg/day

  • Methotrexate 15 mg weekly

06

What researchers measure

Primary outcomes

  1. change in BPDAI (Bullous Pemphigoid Disease Area Index) score

    change in BPDAI (Bullous Pemphigoid Disease Area Index) score after treatment with prednisolone and methotraxate Vs Prednisolone and dapsone Score range from 0-360 (Minimum 0 and maximum 360) higher scores indicating greater disease activity

    Time frame: 8 weeks and 16 weeks

Secondary outcomes

  1. change in serum BP180

    change in serum BP180 after treatment with prednisolone and methotraxate Vs Prednisolone and dapsone

    Time frame: 16 weeks

  2. the remission rate

    remission is defined as complete subsidence of all lesions without prednisolone or minimal prednisolone dose of 10 mg or less

    Time frame: 8 weeks and 16 weeks

  3. the cumulative prednisolone dose

    cumulative prednisolone dose after treatment with prednisolone and methotraxate Vs Prednisolone and dapsone

    Time frame: 16 weeks

  4. time to the initial flare

    time to the initial flare after treatment with prednisolone and methotraxate Vs Prednisolone and dapsone

    Time frame: 16 weeks

  5. number of flares in study groups

    number of flares in study groups after treatment with prednisolone and methotraxate Vs Prednisolone and dapsone

    Time frame: 16 weeks

  6. change in the Dermatological life quality index (DLQI)

    change in the Dermatological life quality index (DLQI) after treatment with prednisolone and methotraxate Vs Prednisolone and dapsone maximum of 30 and a minimum of 0 The higher the score, the more quality of life is impaired.

    Time frame: 8 weeks and 16 weeks

  7. treatment-emergent adverse events

    treatment-emergent adverse events in both the groups

    Time frame: 16 weeks

07

Study locations

1 site
  • AIIMS Bhubaneswar
    Bhubaneswar, Odisha 751019, India
08

References and documents

Publications

  • Lu L, Chen L, Xu Y, Liu A. Global incidence and prevalence of bullous pemphigoid: A systematic review and meta-analysis. J Cosmet Dermatol. 2022 Oct;21(10):4818-4835. doi: 10.1111/jocd.14797. Epub 2022 Feb 1. PubMed 35080093 ↗
  • Chen X, Zhang Y, Luo Z, Wu Y, Niu T, Zheng J, Xie Y. Prognostic factors for mortality in bullous pemphigoid: A systematic review and meta-analysis. PLoS One. 2022 Apr 15;17(4):e0264705. doi: 10.1371/journal.pone.0264705. eCollection 2022. PubMed 35427358 ↗
  • Genovese G, Di Zenzo G, Cozzani E, Berti E, Cugno M, Marzano AV. New Insights Into the Pathogenesis of Bullous Pemphigoid: 2019 Update. Front Immunol. 2019 Jul 2;10:1506. doi: 10.3389/fimmu.2019.01506. eCollection 2019. PubMed 31312206 ↗
  • Patton T, Korman N. Role of methotrexate in the treatment of bullous pemphigoid in the elderly. Drugs Aging. 2008;25(8):623-9. doi: 10.2165/00002512-200825080-00001. PubMed 18665656 ↗
  • Tirado-Sanchez A, Diaz-Molina V, Ponce-Olivera RM. Efficacy and safety of azathioprine and dapsone as an adjuvant in the treatment of bullous pemphigoid. Allergol Immunopathol (Madr). 2012 May-Jun;40(3):152-5. doi: 10.1016/j.aller.2010.12.009. Epub 2011 Apr 14. PubMed 21497011 ↗
  • Sticherling M, Franke A, Aberer E, Glaser R, Hertl M, Pfeiffer C, Rzany B, Schneider S, Shimanovich I, Werfel T, Wilczek A, Zillikens D, Schmidt E. An open, multicentre, randomized clinical study in patients with bullous pemphigoid comparing methylprednisolone and azathioprine with methylprednisolone and dapsone. Br J Dermatol. 2017 Nov;177(5):1299-1305. doi: 10.1111/bjd.15649. Epub 2017 Oct 29. PubMed 28494097 ↗
  • Rashid H, Lamberts A, Diercks GFH, Pas HH, Meijer JM, Bolling MC, Horvath B. Oral Lesions in Autoimmune Bullous Diseases: An Overview of Clinical Characteristics and Diagnostic Algorithm. Am J Clin Dermatol. 2019 Dec;20(6):847-861. doi: 10.1007/s40257-019-00461-7. PubMed 31313078 ↗
  • Reunala T, Salmi TT, Hervonen K. Dermatitis herpetiformis: pathognomonic transglutaminase IgA deposits in the skin and excellent prognosis on a gluten-free diet. Acta Derm Venereol. 2015 Nov;95(8):917-22. doi: 10.2340/00015555-2162. PubMed 26059085 ↗

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Ran from Aug 2023 to primary completion in Jan 2025, 17 months.

How these figures are worked out, and which studies are left out of them.

Registered
Jul 24, 2023
First posted
Aug 9, 2023
StartActual
Aug 1, 2023
Primary completionActual
Jan 3, 2025
CompletionActual
Apr 1, 2025
Last update
Aug 14, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Aug 14, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT05984381
Lead sponsor
All India Institute of Medical Sciences, Bhubaneswar
Responsible party
Dr. Monalisa Jena, M.D. (Additional Professor, All India Institute of Medical Sciences, Bhubaneswar) — Principal investigator
First posted
Aug 9, 2023
Start date
Aug 1, 2023
Primary completion
Jan 3, 2025
Completion
Apr 1, 2025
Last update
Aug 14, 2025

Study contacts

Rituparna Maiti, MD
study director · Professor

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Dapsone

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