## 4 Discussion  
The aim of this study was to investigate if BP180 ELISA may influence clinical severity and prognosis in patients with OMMP. Greater BP180 ELISA values (\(>\)20 U/mL) emerged as correlating with both clinical severity (ODSS) and relapse. Seventeen out of forty-four patients (38%) had BP180 levels above the recommended cut-off (20 U/mL) and values of ODSS greater than patients with BP180 levels below the \begin{table}
\begin{tabular}{l l l l l l} \hline \hline
**Clinical Variable** & \begin{tabular}{l} **In Remission** \\ **(Any Type)** \\ \end{tabular} & \
\begin{tabular}{l} **Time to** \\ **Remission (Months)** \\ \end{tabular} & **Relapse** &
\begin{tabular}{l} **Time to** \\ **Relapse** \\ \end{tabular} & \(p\)**-Value** \\ \hline  & \(n\) & **Mean \(\pm\) SD** & & **Mean \(\pm\) SD** & \\ \hline Sex & & & & & 0.89 \\ F & 30/44 & \(11.6\pm 11.53\) & 13/39 & \(10.84\pm 9.27\) & & \\ M & 9/44 & \(9.88\pm 10.04\) & 4/39 & \(12.5\pm 9.94\) & & \\ Age & & & & & 0.38 \\ \(<\)65 & 19/44 & \(11.94\pm 13.46\) & 8/39 & \(13.87\pm 10.57\) & & \\ \(>\)65 & 20/44 & \(10.5\pm 8.58\) & 9/39 & \(8.88\pm 7.49\) & & \\ Eosinophils & & & & & 0.22 \\ Absent & 30/44 & \(12.66\pm 11.85\) & 16/39 & \(11.18\pm 9.43\) & & \\ Detectable & 9/44 & \(6.33\pm 6.42\) & 1/39 & 12 & & \\ Band-like infiltrate & & & & & 0.77 \\ Absent & 36/44 & \(11.11\pm 11.09\) & 16/39 & \(11.31\pm 9.43\) & & \\ Detectable & 3/44 & \(12.33\pm 13.65\) & 1/39 & 10 & & \\ IgA deposit & & & & & 0.40 \\ Absent & 31/44 & \(9.77\pm 8.49\) & 14/39 & \(10.35\pm 8.69\) & & \\ Detectable & 8/44 & \(16.75\pm 17.77\) & 3/39 & \(15.33\pm 12.09\) & & \\ IgM deposit & & & & & 0.60 \\ Absent & 35/44 & \(11.11\pm 11.59\) & 15/39 & \(10.4\pm 9.34\) & & \\ Detectable & 4/44 & \(13.75\pm 7.5\) & 2/39 & \(17.5\pm 4.94\) & & \\ C3 deposit & & & & & 0.91 \\ Absent & 4/44 & \(16.25\pm 8.42\) & 2/39 & \(9.0\pm 7.07\) & & \\ Detectable & 35/44 & \(10.62\pm 11.32\) & 15/39 & \(11.53\pm 9.54\) & & \\ BP180 ELISA & & & & & 0.009 \({}^{*}\) \\ BP180 \(<\) 20 & 24/44 & \(9.04\pm 8.45\) & 8/39 & \(13.0\pm 9.35\) & & \\ BP180 \(>\) 20 & 15/44 & \(11.64\pm 7.97\) & 9/39 & \(9.66\pm 9.20\) & & \\ ODSS & & & & & 0.13 \\ ODSS \(<\) 20 & 28/44 & \(11.39\pm 12.04\) & 11/39 & \(13.72\pm 10.36\) & & \\ ODSS \(>\) 20 & 11/44 & \(14.66\pm 14.0\) & 6/39 & \(6.66\pm 3.72\) & & \\ Therapy & & & & & 0.51 \\ Local therapy & 17/44 & \(7.76\pm 7.61\) & 6/39 & \(8.0\pm 7.07\) & & \\ Local and Systemic & 22/44 & \(13.86\pm 12.72\) & 11/39 & \(13.0\pm 9.94\) & & \\ Type of Clinical & & & & & 0.35 \\ remission & & & & & 0.35 \\ PRmT & 16/44 & \(5.31\pm 4.89\) & 5/39 & \(10.00\pm 12.02\) & & \\ CRmT & 21/44 & \(16.42\pm 12.40\) & 12/39 & \(11.75\pm 8.24\) & & \\ PRoT & 2/44 & \(3.50\pm 0.70\) & 0/39 & NA & & \\ CRoT & 0/44 & NA & NA & NA & \\ Total & 39/44 & \(11.20\pm 11.10\) & 17/39 & \(11.23\pm 9.14\) & & \\ \hline \hline \end{tabular} ODSS—oral disease severity score; SD—standard deviation. An asterisk (*) denotes a statistically significant association.  
\end{table} 
Table 2: Relapse rates in patients achieving clinical remission according to studied clinical variables. cut-off (19.47 \(\pm\) 6.70 vs. 12.44 \(\pm\) 5.40 \(p\) = 0.001). This suggests that despite the diagnostic limits due to low sensitivity related to low levels of circulating antibodies, OMMP BP180 ELISA may serve as a biomarker of clinical severity. At the same time, BP180 was the only variable associated with relapse, as OMMP patients with BP180 ELISA \(>\) 20 U/mL tended to relapse earlier after the achievement of clinical remission. Therefore, BP180 ELISA at diagnosis could be helpful to intercept OMMP patients who will experience worse clinical behavior in terms of relapse. More in detail, the Kaplan-Meier analysis suggests that patients with different levels of BP180 might benefit from different clinical management and treatment regimens to delay relapse.