Akademik Veri Yönetim Sistemi
4TH INTERNATIONAL MEDICAL CONGRESS OF IZMIR DEMOCRACY UNIVERSITY, İzmir, Türkiye, 09 Aralık 2022 - 11 Ocak 2023, cilt.1, sa.339, ss.256-262
Abstract
Introduction and Purpose: Bullous pemphigoid (BP) is the most common autoimmune bullous disease
characterized by autoantibodies against the hemidesmosomal proteins BP180 and BP230. Beyond their
antimicrobial affects, tetracyclines have been using in BP for their anti-inflammatory properties (1).
However, their effective role on the blood cell markers remains uncertain. In this study we aim to
determine the effects of tetracyclines on hematological parameters including peripheral blood cell
counts, red cell distribution width (RDW); neutrophil to lymphocyte ratio (NLR), monocyte to
lymphocyte ratio (MLR); platelet to lymphocyte ratio (PLR); eosinophil to lymphocyte ratio (ELR),
mean platelet volume (MPV); C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR),
which are the indicators of inflammatory diseases.
Materials and Methods: Thirty patients diagnosed with BP who were on remission under doxycycline
(n=20) or tetracycline (n=10) along with superpotent topical corticosteroid therapy, were enrolled in this
cross-sectional study. The hematological parameters of the patients before starting tetracycline antibiotic
treatment and in the third month of treatment were evaluated retrospectively.
Results: 66.7% (n=20) of the patients were female and 33.3% (n=10) were male with the mean age of
71.5±14.4 years. The clinical and demographical characteristics of the patients with BP are presented in
Table 1. When hematological parameters were compared in the whole study group, there were
significant decrease in monocyte counts, MLR and CRP level from the baseline to the third month of
the treatment (p:0.03; p:0.02; p:0.006; respectively) (Table 2). When the treatment subgroups were
compared; doxycycline users (median:14.65) had more lower levels of RDW than the tetracycline users
(median:16.40) (p:0.01), while the both groups had comparable levels of peripheral blood cell counts,
NLR, MLR, PLR, ELR, MPV, CRP and ESH in the third month of the treatment. At the end of the
treatment period, the eosinophil level was significantly lower in the remission group (median:0.3) than
in the relapsed group (median:1.0) (p:0.033). There was no significant difference in the other peripheral
blood cell counts between the remission and the relapsed group. ELR was significantly lower in the
remission group both in the baseline (median:0.03) and third month of the treatment (median: 0.14) than
the relapsed group (medianbaseline: 0.46, median3.month: 0.55) (p:0.016, p: 0.003, respectively).
Discussion: A large randomized multicenter study reported doxycycline as a safer alternative to
systemic corticosteroids in patients not suitable for long-term systemic steroid use (1). In our study,
RDW level was significantly lower in doxycycline users while, both doxycycline and tetracycline had
similar effects on the other hematological parameters. Peripheral monocyte counts, MLR and CRP,
which did not differ between the remission and relapsed group, were significantly lower at the end of
the treatment period. Notably, peripheral eosinophil count which was found to be correlated with BP
disease activity score in a study; was significantly higher in relapsed group (2).
Conclusion: Except for RDW, both doxycycline and tetracycline had comparable effects on the
hematological parameters. Peripheral eosinophil count and ELR may be a marker for evaluation of response
to tetracyclines in BP patients.