{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:17:15Z","timestamp":1787797035244,"version":"build-2784847793"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100005897","name":"French Society of Dermatology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005897","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,23]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Superpotent topical corticosteroids (STS) are highly effective in bullous pemphigoid (BP), but prolonged use is associated with practical limitations and a risk of relapse.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To evaluate whether combining short-term STS with methotrexate (MTX) could maintain efficacy, reduce relapses and preserve safety compared with prolonged STS alone.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this multicentre randomized open-label noninferiority trial, adults with BP were assigned to receive either STS (clobetasol propionate) for 1\u2005month plus low-dose MTX as maintenance (MTX + STS arm), or prolonged STS alone (STS arm). The primary endpoint was 9-month overall survival (OS), with a predefined noninferiority margin of 15%. Secondary outcomes included relapse-free survival (RFS) and serious adverse events (SAEs).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 266 randomized patients (mean age 80.8\u2005years), 9-month OS was 86.5% in the MTX + STS arm and 83.5% in the STS arm [P = 0.498; hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.40\u20131.50]. The lower limit of the 90% CI for the difference in survival rates (\u22124.6%) remained within the predefined noninferiority margin, meeting the primary endpoint. Among the 87.4% of patients who achieved disease control within 28\u2005days, relapse occurred in 31 patients in the MTX + STS arm and 52 in the STS arm, corresponding to a 9-month RFS of 68.4% (95% CI 59.3\u201378.8) vs. 47.4% (95% CI 37.7\u201359.5), respectively (P = 0.042). SAEs were more frequent in the MTX + STS arm than in the STS arm [mean number per patient per month 0.40 (95% CI 0.23\u20130.57) vs. 0.19 (95% CI 0.01\u20130.36), P = 0.005]. One limitation of this study was its open-label design. Moreover, it did not include a validated disease activity score and was conducted in a selected BP population managed under clinical trial conditions.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Maintenance therapy with low-dose MTX is noninferior to prolonged STS in terms of survival and is associated with a reduced risk of relapse, at the cost of increased toxicity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/bjd\/ljag094","type":"journal-article","created":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T12:45:10Z","timestamp":1772887510000},"page":"38-47","source":"Crossref","is-referenced-by-count":2,"title":["Combined methotrexate and short-term superpotent topical corticosteroids compared with prolonged superpotent topical corticosteroids alone in bullous pemphigoid: a multicentre, noninferiority randomized clinical trial"],"prefix":"10.1093","volume":"195","author":[{"given":"Olivier","family":"Dereure","sequence":"first","affiliation":[{"name":"Department of 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