<h2>Mortality can be more than three times higher in patients with bullous pemphigoid compared with the age-matched general population1</h2>

<h3>The mortality of bullous pemphigoid</h3>
<h4>The 1-year mortality rate ranges from&nbsp;20 to 40%&nbsp;in patients with bullous pemphigoid1–5</h4>
<h4>In a systematic review and meta-analysis of observational studies, a 3.4-fold increased mortality was observed among patients with bullous pemphigoid compared with the age-matched general population1</h4>
A Kaplan-Meier curve depicting survival in patients with bullous pemphigoid vs general population. Patients with bullous pemphigoid have a 3.4-fold increased mortality (N=287)a 1

Figure adapted from Kridin K, et al. Acta Derm Venereol. 2019
aRetrospective cohort study comparing mortality in patients with bullous pemphigoid (N=287) diagnosed between 2000 and 2015 in Israel versus age- and sex-matched controls.1

<h3>Prognostic factors associated with mortality in bullous pemphigoid6–11</h3>
Various factors are associated with poor disease outcomes in bullous pemphigoid:

Prognostic variables for&nbsp;mortality in bullous pemphigoid&nbsp;can include:
<ul>
 <li>Higher dosage of systemic corticosteroids/immunosuppressive drugs6</li>
 <li>Older age at onset and poor performance scale (Karnofsky)&nbsp;6–9</li>
 <li>Low serum albumin levels6</li>
 <li>Multimorbidity and certain comorbidities (e.g. neurological, cardiac, and renal comorbidities)8,10,11</li>
</ul>

High serum anti-BP180 IgG levels are&nbsp;associated with increased 1-year mortality rates&nbsp;in bullous pemphigoid12,13
Additionally,&nbsp;autoantibody profiles may help predict bullous pemphigoid disease course and occurrence of relapse12,14,15

<h3>The impact of bullous pemphigoid on patients’ lives</h3>
<h4>Bullous pemphigoid often leads to substantial physical discomfort and limitations from severe itch and painful eczematous lesions, blisters, and erosions.16–21 This can result in mental, emotional, and socioeconomic burdens and severely impair patients’ quality of life.19, 22–24</h4>

Learn about bullous pemphigoid and its clinical characteristics

What is bullous pemphigoid?

Learn about the key challenges to consider when treating bullous pemphigoid

The challenges of managing bullous pemphigoid

Learn about autoimmunity and the role of type 2 inflammation in the pathophysiology of bullous pemphigoid

What are the contributing factors in bullous pemphigoid?

Learn more about bullous pemphigoid treatment approaches and the current unmet needs

Current treatment approaches and unmet needs in bullous pemphigoid

References

Many factors, including older age and multimorbidity, are associated with mortality in bullous pemphigoid. Read this article to find out more

Patient morbidity and mortality in BP

BULLOUS-PEMPHIGOID

DERMATOLOGY

<table border="1" cellpadding="10" cellspacing="1">
 <tbody>
 <tr>
 <td colspan="3" style="background-color: rgb(244, 242, 246);">Additional&nbsp;Signals</td>
 </tr>
 <tr>
 <td style="background-color: rgb(244, 242, 246);">Physiological&nbsp;Signals</td>
 <td style="background-color: rgb(244, 242, 246);">Advantages</td>
 <td style="background-color: rgb(244, 242, 246);">Limitations</td>
 </tr>
 <tr>
 <td>Continuous ketone and lactate sensors</td>
 <td>Lactate increase with exercise and can differentiate moderate-intensity exercise and high-intensity exercise. 
 Ketone responds to different types of exercises. These levels ensure safety during exercise.</td>
 <td>Very limited ability to differentiate between the type of exercise, and mixed levels show a slow increase with exercise</td>
 </tr>
 <tr>
 <td>Accelerometers and heart-rate sensors coupled with lactate sensing</td>
 <td>Might have potential to inform CL on both exercise type (E.g., running, swimming or weights) and intensity (low, moderate, high or interval)</td>
 <td>Non-specificity to exercise with stress, illness, medications, dehydration, and all potential modulators</td>
 </tr>
 </tbody>
</table>

<ul>
 <li>
 Information from&nbsp;physiological signals&nbsp;like lactate, ketones, counterregulatory hormones, accelerometry, heart rate, galvaic skin response, skin temperature, and blood volume pulse could be used as potential adjunct for developing an algorithm about onset, offset and intensity of physical activity.</li>
 <li>
 Counterregulatory hormones&nbsp;can differentiate exercise intensity, however a lot of technical challenges were involved in measurement of them in real world.</li>
 <li>
 Other wearable&nbsp;sensors combining galvanic skin response, accelerometry, blood volume pulse, heart and skin temperature&nbsp;are able to classify the physical states and exercise type and could potentially differentiate exercise and physiological stress.</li>
</ul>

Additional signals

OTHER-DIABETES-TOPICS

DIABETES

<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td colspan="3" style="background-color: rgb(244, 242, 246);">
 Bi-hormonal CL systems 
 (Systems delivering both Insulin and glucagon)</td>
 </tr>
 <tr>
 <td style="background-color: rgb(244, 242, 246);">Strategies</td>
 <td style="background-color: rgb(244, 242, 246);">Advantages</td>
 <td style="background-color: rgb(244, 242, 246);">Limitations</td>
 </tr>
 <tr>
 <td>Glucagon helps in minimizing the impact of the delayed onset in insulin action by counteracting the persisting glucose-lowering effects of insulin</td>
 <td>
 <ul>
 <li>
 Bypass limitations of SC route</li>
 <li>
 Improved time-in-range</li>
 <li>
 Less hypoglycemia during excercise</li>
 </ul></td>
 <td>
 <ul>
 <li>
 Stability and cost</li>
 <li>
 Long-term safety of glucagon</li>
 <li>
 Increased complexity of the system</li>
 </ul></td>
 </tr>
 </tbody>
</table>

BI hormonal CL systems

<h2>Improved usability of existing strategies</h2>
An&nbsp;exercise button&nbsp;could be integrated into CL device activation which triggers several adaptive changes, such as:
<ul>
 <li>
 Automatic increase in glucose at a preset time</li>
 <li>
 Modifications in the algorithm so that it becomes less aggressive in minimizing rises in glucose levels and more aggressive in minimizing falls in glucose</li>
 <li>
 A function to preprogram future recurrent scheduling for exercise (date and time) which could automatically set temporary targets 90 minutes prior.</li>
</ul>

Improved usability


<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td colspan="3" style="background-color: rgb(244, 242, 246);">Development of insulin formulations and routes of delivery with more favorable pk characteristics</td>
 </tr>
 <tr>
 <td style="background-color: rgb(244, 242, 246);">Strategies</td>
 <td style="background-color: rgb(244, 242, 246);">Advantages</td>
 <td style="background-color: rgb(244, 242, 246);">Limitations</td>
 </tr>
 <tr>
 <td>Intranasal insulin</td>
 <td>Significantly faster onset and offset in action with potential to reduce residual insulin activity associated with pre-exercise meal bolus</td>
 <td>
 <ul>
 <li>
 Not widely available</li>
 <li>
 Long-term safety is not clear</li>
 </ul></td>
 </tr>
 <tr>
 <td>Continuous intraperitoneal insulin infusion</td>
 <td>
 <ul>
 <li>
 Faster onset and offset action</li>
 <li>
 Improves HbA1c with less hypoglycemia</li>
 </ul></td>
 <td>
 <ul>
 <li>
 Invasive procedures</li>
 <li>
 Carries risk of infection and immunogenicity</li>
 </ul></td>
 </tr>
 <tr>
 <td>Intravenous (IV) CL insulin delivery models</td>
 <td>
 <ul>
 <li>
 Rapid delivery with no delay in absorption</li>
 <li>
 Would bypass limitations of SC route</li>
 </ul></td>
 <td>
 <ul>
 <li>
 Invasive</li>
 <li>
 Prone to complications such as infections, thrombosis</li>
 <li>
 Less feasible for ambulatory use</li>
 </ul></td>
 </tr>
 </tbody>
</table>

Development of Insulin

<table border="1" cellpadding="10" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td colspan="3" style="background-color: rgb(244, 242, 246);">Enhanced algorithms</td>
 </tr>
 <tr>
 <td style="background-color: rgb(244, 242, 246);">Strategies</td>
 <td style="background-color: rgb(244, 242, 246);">Advantages</td>
 <td style="background-color: rgb(244, 242, 246);">Limitations</td>
 </tr>
 <tr>
 <td>HCL systems incorporating heart rate, accelerometry along with energy expenditure and galvanic skin response</td>
 <td>For detection of physical activity and improvements in glycemic outcomes</td>
 <td>These algorithms reactive and remain subject to the slower PK of subcutaneous insulin absorption</td>
 </tr>
 <tr>
 <td>Machine learning for personalization of CL systems</td>
 <td>Recognizes habitual pattern of imminent exercises and trigger CL systems</td>
 <td>Potential risks associated with insulin dosing determined upon the basis of the probability of an event occurring</td>
 </tr>
 </tbody>
</table>

Enhanced algorithms


A series of videos that shows Prof Kausik Ray, Cardiologist and Professor of Public Health, Imperial College London, presenting the ACS Story narrative in a visually engaging way.
Please explore the 4 mini videos below to learn more on how to implement the guidelines recommendations and achieve higher clinical benefits for your patient

The first chapter talks about how to identify patients at very high CV risk.

Patient Identification

The second chapter talks through how to manage patients in alignment to the guidelines.

Treat Aggressively, Combine and Treat Early

The third chapter talks through how to optimise the ACS pathway.

Optimise Your ACS Pathway

Summary on the ACS patient journey and ESC guidelines recommendation for physician on how to manage patients efficiently.

Summary

Act Now for your ACS Patients

DYSLIPIDEMIA

Meet a Sanofi Specialist

OTHER-RARE-DISEASE-TOPICS

RARE-DISEASE

cGVHD is the&nbsp;most common complication of alloHSCT, leading to significant multi-organ damage and affecting&nbsp;~54%&nbsp;of patients annually and increasing both premature mortality and healthcare costs.1

black

Among patients undergoing alloHSCT, approximately 54% develop cGVHD, out of which ~35% experience a moderate form and ~30% a severe form of the disease.1

A substantial proportion of patients with cGVHD present with concomitant inflammatory and fibrotic manifestations.2
<ul>
 <li>Up to 50% of patients with moderate cGVHD and 60% with severe disease may exhibit lung involvement, which can manifest as bronchiolitis obliterans, a fibrotic manifestation that can be especially difficult to treat.3</li>
</ul>

Non-relapse mortality continues to increase over time in patients with cGVHD reaching 22% after 5 years.14

Direct costs increase by 1.5 times in mild cGVHD and 4 times in moderate to severe cGVHD, compared with patients post-alloHSCT without cGVHD.15

Social functioning, physical functioning, general health, and other QoL components are worsened with cGVHD progression.16-17

Abbreviations
alloHSCT:&nbsp;Allogeneic hematopoietic stem cell transplantation;&nbsp;cGVHD:&nbsp;Chronic graft-versus-host disease;&nbsp;QoL:&nbsp;Quality of life.

cGVHD Burden

PAYOR

OUT-OF-TAXONOMY

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