Main Plenary Sessions

Abstract

O01 Assessing the impact of the BLISTER trial on the use of tetracyclines to treat bullous pemphigoid in the U.K. A. Lloyd-Lavery, J. Chalmers, K. Harman, S. Dowey, G. Kirtschig, M. McPhee and H. Williams Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, U.K., Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K. and Department of Dermatology, University Hospital Marburg, Marburg, Germany The purpose of conducting pragmatic clinical trials that produce results relevant to clinical care is to change practice for patient benefit. The BLISTER trial, published in April 2017, found that a strategy of starting patients with bullous pemphigoid (BP) on doxycycline 200 mg daily produced acceptable short-term blister control at 6 weeks and a halving of treatment-related severe, life-threatening and fatal events at 52 weeks compared with starting on prednisolone at 0.5 mg kg per day (Williams HC, Wojnarowska F, Kirtschig G et al. Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic non-inferiority randomized controlled trial. Lancet 2017; 389: 1630–8). To assess the impact of the BLISTER trial, we performed two national surveys before and after the BLISTER trial results were published. SurveyMonkey online questionnaires were distributed to the U.K. Dermatology Clinical Trials Network and British Association of Dermatologists in November 2015 and February 2018. For the preand post-publication surveys, 113 and 74 responses were received, respectively. The prepublication survey demonstrated uncertainty in the value of using tetracyclines to treat BP: only 18.6% believed tetracyclines were definitely beneficial in the treatment of BP and 28.3% were unsure. Around half of respondents (45.5%) sometimes used tetracyclines as part of their management of patients with BP. In the post-publication survey, 84% of respondents stated that the BLISTER trial results had influenced their management of patients with BP; 30% had not previously used tetracyclines but now planned to do so and 57% had previously used tetracyclines but the way in which they used them had changed because of the BLISTER trial results. Various factors influenced these changes in practice: 91% of respondents who had changed their practice stated it was because the BLISTER trial showed doxycycline to be sufficiently effective and 79% reported it was because doxycycline was shown to be safer than prednisolone. Individual comments from respondents indicated an increased confidence in prescribing tetracyclines because of more robust evidence supporting their use, which facilitates a more evidence-based discussion with patients when considering treatment options. In the light of the BLISTER trial, 38% suggested national guidelines for BP management should be updated. An update of the British Association of Dermatologists guidelines for the management of BP is currently under way. Although it can take up to 17 years for new evidence to be fully implemented, these surveys indicate that the BLISTER trial results have already influenced the clinical management of BP in the U.K.